
(Jass_ 

Book '£"?y 



LETTERS TO LADIES, 



DETAILING 

3 k 



IMPORTANT INFORMATION, 



CONCERNING 



THEMSELVES AND INFANTS. 



BY THOMAS EWELL, M. B. 

OF VIRGINIA. 

Honorary Member of the Philadelphia Medical Society, and former 
Surgeon to the Navy Hospital of Washington City. 



WITH NINE ENGRAVINGS. 



PHILADELPHIA c f 

PRINTED BY W. BROWN, PRUNE STREET. 

4817. 






^ 



\i> 






tHstrict of Pennsylvania, to -wit : 

BE IT REMEMBERED, That, on the ninth day of September, in 
the forty-second year of the Independence of the United States of 
America, A. D. 1817, Thomas Ewell, of Virginia, hath deposited in this 
office the title of a book, the right whereof he claims as proprietor, in 
the words following, to wit : 

*' Letters to Ladies, detailing important information, concerning them- 
" selves and infants. By Thomas Ewell, M. D. of Virginia. Honorary 
" Member of the Philadelphia Medical Society, and former Sur- 
" geon to the Navy Hospital of Washington City." 

In conformity to the act of Congress of the United States, entitled 
** An act for the encouragement of learning, by securing the copies of 
maps, charts, and books, to the authors and proprietors of such copies, 
during the times therein mentioned." — And also to the act entitled 
*' An act supplementary to an act, entitled 'An act for the encourage- 
ment of learning, by securing the copies of maps, charts, and books, to 
the authors and proprietors of such copies, during the times there- 
in mentioned,' and extending the benefits thereof to the arts of de- 
signing, engraving, and etching historical and other prints." 

D. CALDWELL, 

Clerk of the district of Pennsylvania. 



LETTERS TO LADIES, 

EXPLAINING PARTICULARLY, 

First, The means of purifying the person- 
teeth and mouth — and of preventing and curing 
the diseases peculiar to women. 

Secondly, The services they should direct, su- 
perintend, or perform for each other at births, to 
supersede the employment of men midwives. 

Thirdly, The treatment of children for the pre* 
vention and cure of their disorders. 

And several other subjects of importance to be 
understood by women, 



DEDICATION. 

To the Wives of the Ministers of the Gospel of 
the United States. 

Ladies, 

It is not more on account of your respectabi- 
lity that I inscribe these Letters, than from the 
influence which your example must have with the 
generality of your sex. You will never refuse to 
join in the work of promoting female delicacy and 
usefulness ; and therefore I ask you not only to 
read these letters seriously, for your own good, and 
for the good of the offspring rising to take charge 
of the country — but to assist me in persuading all 
women to devote a few hours to the consideration 
of the subjects thus pressed upon their attention. 

In the fulness of prosperity, with feelings of 
health, of comfort, of pleasure, we seldom think 
of the sufferings of others, of the sufferings which 
may come to ourselves. But others are encounter- 
ing pains, and to ourselves diseases are advanciug ! 
To lessen the one, to ward off the other, where is 
the rational woman who could withhold her powers? 
The road to the Eternal Heaven is through huma- 
nity ; the road to earthly happiness is through 
health, preserved by the vigorous application of 
sense ; roads never to be traversed by those who 
entomb their powers. It being declared in the 
gospel, that future rewards will vary as one star 
differeth from another, you should bear in remem- 



VI DEDICATION. 

brance, that the more useful and attentive will not 
only live in superior enjoyments, but in a better 
world will move in greater glory. Such a stimu- 
lus for each of you to exert yourselves, that you 
may for ever feel the blessings of doing and re- 
ceiving good, should overpower every opposing 
inclination. 

To make yourselves, and to persuade the sex to 
become acquainted with the subjects of these let- 
ters, is not all that I have to suggest to you. I 
have to entreat you to induce your husbands to so- 
licit subscriptions of money from their respective 
parishes, to establish, at the capital of the union, an 
institution for promoting these important objects. 
The plan is annexed, and so unexceptionable, that, 
if earnestly attended to, must eventuate in the 
foundation of an establishment for relieving, in the 
best manner, the poor in child -bed, for instructing 
women correctly in the principles of midwifery, 
and for supporting those who have not funds for 
their expenses during the study ; so that the ladies 
in every part of the country may receive some fe- 
male operator ; inspiring confidence in all, and re- 
lieving many from mutilation and death. 

That you may be instrumental in founding so 
great an institution, which will be a monument to 
humanity, which will be for ever remembered and 
felt by your country to its remotest parts, is, ia~ 
dies, one of the warmest prayers of 

Your obedient servant, 

THOMAS EWELL, 



Plan for establishing an institution for the benefit 
of the foor and rich women and infants through- 
out the United States. 

1. Every minister in the United States to solicit 
from his congregation, publicly or privately, on or 
before the beginning of the ensuing year, such con- 
tributions as can be obtained. 

2. Each shall retain the amount in his hands, un- 
til publicity is given of the formation of a society in 
the District of Columbia, composed of all the minis- 
ters of the District. 

3. The ministers (it is supposed impossible that 
any one can refuse to co-operate) shall assemble 
and form such a constitution, and appoint such of- 
ficers as they shall approve. 

4. The officer appointed shall then receive one 
half the amount paid to each minister, and the so- 
ciety shall immediately purchase a large square in 
the City of Washington, if the government refuse 
to give it for the purpose, and erect thereon, instead 
of an ostentatious building, numerous plain small 
houses, adjacent to each other, for receiving all wo- 
men in advanced pregnancy, who may desire to be 
admitted, without respect to persons or forms, who 
shall be supplied with needful articles, and good 
attendants. 

5. The society shall appoint such physicians as 
they may deem best qualified to instruct (until one 



viii PLAN, &c. 

woman becomes qualified) all women who shall at- 
tend to acquire a knowledge of the business of a 
midwife, in a course of lectures to be delivered 
every three months. The attendants always to live 
in the houses, to witness the delivery of those in 
labour ; and after attending two courses of lec- 
tures, shall undergo examination, and, if found 
qualified to act, shall receive a certificate from the 
physicians of the same. 

6. The ministers receiving the subscriptions shall 
retain the half, and, from time to time, apply it to 
the support of such females of their parish, as are 
desirous of learning midwifery, and cannot defray 
the expenses. 



PREFACE. 



A long time lias elapsed, since I promised a 
publication on the subjects treated of in these let- 
ters. Thoush constantly solicitous to have a few 
weeks spared from my pressing engagements to pre- 
pare them, I could not earlier succeed. I have 
seized the first opportunity, and although I have not 
delayed to give a better dress — -the substance, the 
doctrines, the directions, are as 1 wish, and may be 
safely relied upon by the ladies. 

It was my intention, at one time, not to have an- 
nexed my name to these letters, as I was not ambi- 
tious for any other feeling than that of having made 
the attempt to serve the sex. But it soon appeared 
indispensably necessary, that advice on such im- 
portant subjects, to be properly attended to, should 
come from a responsible man, of regular profes- 
sional education. 

The part relating to the offices women should 
perform to each other at births, has nothing to recom- 
mend it, but the correctness of the extracts from the 
best writers, occasionally divested of such techni- 
cal terms as could be dispensed with. So much has 
been written on midwifery, and such is the simpli- 
city of the operations of nature for delivery; that it 

b * 



X PREFACE. 

would puzzle ingenuity itself to devise a new idea 
on the subject ; much less an improvement in prac- 
tice. 

I am sensible that it is the opinion of medical 
characters of mind, that, as the world abounds in 
such a variety of books, no man should publish, un- 
less he had something new to communicate. Mv 
chief object is, the instruction of those, who know 
uot what has been published. To disseminate, 
among the uninformed, the improvements of the 
learned, I consider nearly as respectable as mak- 
ing the improvements. To a mind, thinking 
only of doing good, the business of dissemination is 
just as pleasurable as that of discovery. Neverthe- 
less, I am not unconscious of making some original 
suggestions in this work. Had some of them oc^ 
curred to those familiar in the make of books, they 
would have been conveyed in larger volume. The 
necessity of condensation, on the present occasion, 
ought not to prevent their receiving full attention. 
On the subject of exciting the flow of milk from 
fche breasts, particularly iu cases of barrenness, I am 
anxious for an early application, because convinced 
it will prove of general utility. 

How far, in most countries, medicine should be 
trusted in the hands of common people,— is a ques- 
tion of difficult, doubtful decision : for one pre- 
suming medlar has often done as much mischief, as 
the judicious have done good. But, if there be a 
eoimtty in which medical knowledge may be dif- 



PREFACE. XI 

fused, it is in the United States, where professional 
services are so often dilatory and out of time. If 
there be a part of the community to whom this 
knowledge should be confined, it is, assuredly, the 
female part, — at least concerning themselves and 
children. Their delicacy of frame, and sensibility 
of system, leading to speedy termination of disor- 
ders, renders this knowledge, by them, not of ques- 
tionable value, but of most important benefit. In- 
stead of giviug articles to the sick in their fami- 
lies, contrary to proper treatment, or withholding 
some little remedy, equal to the cure in the com- 
mencement, they might, without much intellectual 
exertion, acquire such knowledge as would insure 
essential service ; at least until the arrival of phy- 
sicians. The more they attend to such knowledge, 
they will be endeared the more ; be, as they should, 
contributory to the interests, as to the pleasures of 
mankind. 

To ladies of good candid minds, no apology will 
be necessary for the plain manner in which I have 
stated some subjects, deemed offensive to converse 
about, yet important to health. Only those of af- 
fectation of feeling, can fancy there is indelicacy in 
understanding what may save from exposure, dis- 
ease, and death. I was pleased with a French 
lady, who, shortly after her arrival in my neigh- 
bourhood, sent in the night for a physician to her 
child, suddenly taken alarmingly ill : on his en- 
trance, observing her more than half naked, he was 



XU PREFACE. 

about withdrawing, when the earnest mother ex- 
claimed, in broken English, — " Sacrez ! fool doe- 
tor — you let my child die cause I no dressed." It 
is certain, that the mind in private, with perfect pu- 
rity, turns to every point, and instead of seizing at 
extraordinary means on emergencies, we should 
deliberately, previously acquire qualifications for 
acting. I am conscious I have pressed in this work 
several practices, which many of the respectable 
part of the sex are in the habit of observing, without 
the advice of a physician. Such directions are of- 
fered only to those who do not observe them, and 
the more earnestly to induce those who do, to assist 
in inculcating them among the negligent and unin- 
formed. To produce the stronger impressions in 
other cases, I have purposely repeated the same 
advice. 

PHILADELPHIA, September, 18ir. 
% 



CONTENTS. 



Page. 

Dedication 5 

Plan for a lying-in hospital - - 6 

Preface ... - 9 

Letter First - - 21 
Reasons why females should attend to the subjects 

of the work 32 

Letter Second 33 

Remarks on cleanliness - - - 35 

Objections to perfumes - - ib. 
Best means of removing the filth from the surface 

of the body 36 
Warm-bath - - - -37 

Cheap plan for warming water - - 38 

Rheumatism - - ■ - ib. 

Air-bath - M . - 39 

Cold and salt-bath - - ib 

• 

Cleansing the feet - - - 40 

Preventive of colds - - ib. 

Cleansing the arms ib. 

Sitting daily in cold water - - 41 

Preventive of costiveness 43 

Preventive of the small size of the female person ib. 

Preventive and cure of piles - - 45 

Warts, boils, and fistulas 46 

Excoriations - - - 48 

Of the teeth - - « - ib* 

B 



XIV CONTENTS. 

Page. 

Best tooth powder - - 49 

Decayed teeth - - - 51 
Diseases they produce ... -52 

Extraction strongly advised - - ib. 
Tooth-ache. — The remedies, and caution not to ex- 
tract sound teeth - - -53 

Of the skin 54 

Receipt for making the skin look well - ib. 

Means of softening the skin 55 

To prevent and cure pimples of the skin - 56 

Letter Third - - - 57 
General knowledge of the principles of medicine 

recommended - - - ib. 
Fibres forming the body, possessed of contractile 

power, called irritability - - 58 
Food dissolved in the stomach, and conveyed to the 

blood - - - - ib. 
Circulation of blood ib. 
Principles of animal life - - - 59 
Principles of disease 60 
Principles on which cures^re effected - 61 
Formation of the parts orour bodies, on the princi- 
ples of chemical attractions 62 
Healing of wounds on the same - - 63 
Of fat in our bodies - ib. 
Starvation — means of lessening its rapid destruction 65 
Of sympathy, or particular connection between dif- 
ferent parts of the body - - ib. 
Letter Fourth - - 69 
History of the menses - - ib. 
Cautions during the evacuation - 71 
Irregularities of the discharge - - ib. 
Excessive menstruation - - 72 



CONTEXTS. XV 

Paof, 

Obstructed and suppressed - - 74 

Period of cessation - - -77 

The whites 79 

Hysteric fits - - - 82 

Indigestion 85 

Letter Fifth - - - 89 

Description of female pelvis - - ib. 

Bones of the child's head - - 92 

External parts of the female organs of generation 94 

Their inflammation 95 

Internal parts - - - ib. 

1. The canal to the bladder, called urethra, - ib. 
Obstruction of urine, drawing off the water with 

a catheter 96 
Painful discharge of urine, called stranguary - 99 

2. The birth-place, called vagina - 100 
Its contraction - - - ib. 
It receives the mouth of the womb - 101 
Womb described - - ib. 
Its connections - 102 
The end gut, called rectum, behind the womb - ib. 
Falling down of the womb ^ - - 103 
Falling backwards of the wonw - - ib. 
Turning inside out of the womb - - 104 
Dropsy of female testicle - - 105 
Venereal disease - 106 
Clap, or gonorrhoea ib. 
Pox, or syphilis - 107 
Letter Sixth - - - 111 
Conception - ib. 
Growth of contents of the womb - 112 
Quickening - - - - 115 
Expulsion in forty-two weeks - - 116 
The « waters" - - - 116 



XVI CONTENTS. 

Page. 

The after-birth ib. 

The navel cord - - - 117 

Circulation between mother and child - ib. 

Rules of conduct during pregnancy - 118 

Diseases of pregnancy - - 119 

Inflammation of bowels - - 120 

Of pain in the pubes or front bones - 121 

Of sickness of stomach - - - 122 

Of heart-burn ... ib. 

Of cholic - - - 123 

Of fainting ib. 

Of swelled legs - - - ib. 

Of cramp - - - - 124 

Of flooding - - - 125 

Of abortion, or miscarriage - - 133 

Of barrenness - - - 139 

Letter Seventh - - - 143 

General remarks on delivery - - 146 

History of the operations for the birth of the child ib. 

Cutting the navel cord - - 156 

Delivery of after-birth - - - 157 

Recapitulation to be commuted to memory - 158 

Questions and answers ™- - - 159 

Recapitulation of labour, from Dr. Merriman 162 

Rules for management, from do. - - 165 

Letter Eighth ... 157 

General remarks on the evils of bad management at 

birth ib. 

Of bursting the perineum - - - 169 

Of swellings, and of tearing the birth-place at labour ib. 

Delivery of after-birth, when detained - 170 

Loss of blood at delivery - - ib. 

Pulling down the womb - - 171 



CONTENTS. XV U 

Page. 

Of twins r - - -172 

Of breech presentments - - 174 

Of presentment of feet or knees - - 177 
Of presentations of the head, the forehead, the face, 

and with the hand, or arm - - 178 
Of presentations of parts necessarily requiring in- 
terference - - - 180 

1. Superior extremities - - 181 

2. The back, belly, or sides - 182 

3. The navel cord ib. 
Recapitulation - - - 183 
Difficulties at birth on account of the mother 186 
Defective pelvis ib. 
Delivery of the child by the crotchet - - 187 
Defects in the action of the womb - 190 
Delivery by forceps - - - 192 
Difficulties from after-birth at the mouth of the 

womb - igs 

Labour with convulsions - > - ib. 

Cases of common occurrence - - 197 
Rare cases, from Dr. Bard, of the turning inside out 

of the womb, called inversion - - 202 

Letter Ninth - 209 
General remarks on the treatment of women after 

delivery - ib. 
Directions to be observed for preventing diseases, 

and producing a flow of milk - - 211 

Diet - - . j 214t 

Of giving milk - - -- 218 

Diseases of lying-in women , - - 221 

Fainting after delivery - - ib. 

Chills .... o 2g 

After-pains - ^ \u c 



XV111 CONTENTS. 

Page. 

Local inflammation - 223 

Inflammation of the breast - - 224 

Sore nipples - 227 

Milk fever - - - 229 

Child -bed or puerperal fever - - 230 

Miliary fever - 232 

Common fever - - - 235 

Swelled leg - ib. 

Madness or mania - - 237 

Letter Tenth - - - 239 
General remarks on the treatment of children after 

birth - - - ib. 
Means to prevent their taking cold - 240 
First washing and dressing navel - - 241 
First application to mother's breast - ib. 
Rules for giving nourishment - - 242 
Raising children without the breast - 244 
Moving children - 245 
Diet of mother on account of the child - 246 
Daily washing in warm water - - ib. 
Rocking children - 248 
Proper place for them to sleep — new plan - 249 
Daily causing them to open their bowels - 250 
Of abundance of air for them - - 251 
Of their clothing — to be neither excessive or defec- 
tive - - - - 252 
Exposure to sun and rains - - 253 
Simplicity of diet recommended - ib. 
Bad effects of cake - 254 
Of excess and changes in their diet - 255 
The time for vveaning children - - ib. 
Teething of children - - 256 
Cutting gums universally recommended - 257 



CONTENTS. XIX 

Vxnv.. 

Teaching children to govern themselves - 259 

Letter Eleventh - 261 

Diseases of children - - ib. 

Of early colds - 262 

Eruptions of the skin - - ib. 

Sore eyes - - - 263 

Swellings — excoriations - - 264 

Hooping cough - 265 

Of the croup - ib. 

Wind in the stomach and bowels - - 266 

A sickness with or without throwing up - 269 

The thrush frog, or sore mouth - - 274 

Sore and scald head - ■- 27S 

The measles - 280 

Ofcholic - 285 

Of convulsions - - - 287 

Of fever - - - 291 

Of worms - 299 

Of mumps - 301 
Of cow pock .... 3Q3 

Of chilblains ... 304 

Of scalds and burns - 305 

Itch ib. 

Bowel, or summer complaint - - 307 



C3 3 The reader is requested to correct, in page 103, line 22, as fol- 
lows : erase in and insert retro in the word inversion. 



LETTERS TO LADIES. 



LETTER I. 

Containing reasons why Ladies should attend to the 
subjects of the ivork* 

THE influence of pure, delicate, and cleanly women 
in society has long been the subject of remark. With the 
appearance of but little power, they have borne a sway 
more irresistible than that of males. When mothers have 
been noble or debased, it has often been the consequence 
that men have been refined or depraved. In no age 
has violence imposed on the placable spirits of the sex, 
without severe suffering j not so much from present loss 
of pleasure, as from reaction on the rising generation. 
The interest, the affection, the duty of all require that 
every effort should be made to preserve women delicate 
and virtuous ; to keep them out of the way of tempta- 
tion, as well for the present as succeeding societies. No- 
thing can be more certain, than that in defiance of our 
wishes and expectations, our own daughters will partake 
more or less of the prevailing manners of the times ; will 
be pure and refined, or indelicate or unprincipled, accord- 
ing to their associates. It is therefore obvious, that by 
assisting in the establishment and preservation of good 
practices in the community, we assist in perpetuating them 
among those dearest to our hearts. 

It Avas, ladies, from very sincere feelings to promote 
your welfare that I designed this publication ; feelings, 

B 



2& 

increased by the hope of its tendency to prevent practices 
I deem improper, from extending to my own female de- 
scendants and dearest friends, whose shield and whose 
power, in common with their sex, should rest on their vir- 
tue, their delicacy, and their usefulness. My first object 
was, to arrest the useless, the indelicate, the injurious, yet 
growing practice, of calling on men midwives, in common 
cases of births ; the second object, to ensure better 
treatment of yourselves and children. 

In soliciting your attention to this subject, it is not my 
desire to make you midwives or physicians. I only ask 
you to learn the principles of the facts you have already 
learnt, while gratifying the universal curiosity on the sub- 
ject of the birth of man. Accurately understand, at least 
the outlines, leave nothing to fancy, and you will be able 
to command, to render important services in scenes where 
you have appeared as idle, useless spectators. You will 
be able to direct ignorant attendants, as physicians direct 
nurses at the bed-sides of those delicate patients refusing 
to exhibit their persons. You will not only save the ex- 
pense of male attendants, the wives from disgust, and hus- 
bands from mortification, but what is of vast importance, 
indeed, you will always be able to detect, and forbid the 
officious meddling of the ignorant midwives, sometimes 
terribly destructive to mother and infant. The great im- 
portance alone, of giving these common women proper 
directions, enabling them ever afterwards to act with pro- 
priety, ought to be a sufficient inducement for all of you to 
attend to this subject. 

Many of you pay great attention to the preparation of 
compositions for eating, you do not consider it improper 
to learn that this food is ground under the teeth, blended 
with saliva, swallowed, digested, and then passing through 



28 

the bowels, is discharged by the organ and at the orifice 
assigned for the purpose. Truly then you ought not to 
think it strange, that I should request you to acquire a 
knowledge of the preparation and passage of the human 
body. None of your mixtures for eating, nothing in 
truth, that you have learnt, can be of greater importance. 
You can acquire all the necessary information in less time 
than you require for a novel. The famous Cleopatra of 
Egypt is said to have studied, and written for the public 
on the subject. Should affectation of feeling induce you 
to say that it is too indelicate — how inconsistent will be 
such an assertion with an unnecessary exposure of your 
persons at births, to the hands and eyes of physicians. 

Indeed, it is on account of your delicacy, that I intreat 
you to acquire valuable information respecting your own 
structure. Nature has given you functions to perform, 
every body knows you perform them ; and can you se- 
riously think there is as much indelicacy in endeavouring 
privately to acquire accurate information, as there is in 
your neglect to do it, rendering it almost indispensable to 
expose yourselves to the hands and eyes of strangers ? 

There is not the least reason in the common aversion of 
mothers for their daughters to be acquainted with the his- 
tory of generation before their marriage. Ignorance of 
any subject appearing mysterious, naturally tends to the 
excitement of curiosity ; and it is very likely this ungrati- 
fied curiosity to learn the nature of generation, has in- 
clined females to dishonourable connection. According 
to reason and common sense, assuredly it must appear, 
that for inquisitive girls to act with prudence, it is best 
they should be instructed plainly, that they should be told, 
as Milton represents an angel sent to Adam in Paradise, 
declaring, that sexual connection is not the heaven or hap- 



piness of a rational mind ; that it is an operation common 
to brutes. Learning that there is nothing so greatly -de- 
sirable about it, so wonderfully mysterious, they must be. 
less inclined to yield to a dishonourable prostitution. 
They will the more readily believe, that to be rational and 
proper, there must be a refined regard for the object of 
their love, and their union with him, consummated accord- 
ing to the usages of the virtuous. Indeed, it clearly ap- 
pears to my mind, that a young lady, understanding the 
whole subject, not having had her fancy inflamed by a 
mysterious silence, could not be prevailed upon to tarnish 
by her conduct, the honour of her sex, and dignity of her 
family. 

But this is not the serious object of my present solici- 
tude. It is to wrest the practice of midwifery from the 
hands of men, and to transfer it to women, as it was in the 
beginning, and ever should be. I have seldom felt a more 
ardent desire to succeed in any undertaking, because I 
view the present increasing practice of calling on men in 
ordinary births, as a source of serious evils to child-bear- 
ing : as an imposition upon the credulity of women — and 
upon the fears of their husbands : as a means of sacrificing 
delicacy, and consequently virtue : as a robbery of many 
of the good common women of their proper employment 
and support. Truly it shows as extraordinary a revolution 
in practice, as any afforded from a survey of all the arts. 
That all females do bring forth their young without assist- 
ance, excepting the human in a state of civilization ; and 
that women should call for the assistance of men, the only 
animals tormented by jealousy, is a fact that will scarcely 
be credited in a Turkish Harem, or by the christians of 
some future and purer age. Should the strangers to the 
practice, inquire if our men have large unwieldy hands — 



great curiosity about women ; should they ask if our wo- 
men had the requisites for useful services — small hands — 
good sense of touch, and patience in attendance — they will 
absolutely deny this monstrous perversion of the course of 
nature. 

From the peaceful and retired occupations of women, 
they are generally more numerous in the community than 
men. Nevertheless, the men have assumed several of- 
fices, properly belonging to the weaker sex. The natu- 
ral consequence is, that many women, as men in similar 
circumstances, wanting profitable occupation, seek the em- 
ployments of the vicious. In as much, therefore, as these 
men midwives have meddled with this proper business of 
women, they have been instrumental in the depravity of 
many. Indeed, it is owing to their acting where they are 
not required, that the female practitioners are so often ig- 
norant — not having the opportunity ox means to qualify 
themselves for attendance on ladies. 

Several observing moralists have remarked, that the 
practice of employing men midwives, has increased the 
corruption among married women. Even among the 
French, so prone to set aside the ceremonies among the 
sexes — the immorality of such exposures has been noticed. 
In an anecdote of Voltaire, it is related that when a gentle- 
man boasted to him of the birth of his son, he asked who 
assisted at the delivery : to the answer a man midwife, he 
replied, then you are travelling the road to cuckoldom. 
The acutely observing historian of nature, Count Buffon, 
(on puberty) observes, " virginity is a moral being, existing 
solely in purity of heart. In the submission of women, to 
the unnecessary examinations of physicians, exposing the 
secrets of nature, it is forgotten that every indecency of this 
kind is a violent attack against chastity—that every situa- 



26 

tion which produces an internal blush, is a real prostitu- 
tion." It is very certain, where these exposures have been 
most common, as in large cities, there adultery has been 
most frequent. Be it folly, or prejudice, or not, there is a 
value in the belief, that the husband's hands alone are to 
have access to his sacred wife. Break through the preju- 
dice, if you please to call it so, but for once, unless pow- 
erful reasons command it, the rubicon is passed ; and rely 
upon it, the barriers, on future emergencies, will not be so 
insuperable. Time and opportunity to press on a grateful 
heart, for a favour in regions where magnified favours have 
been conferred, have been used, and more frequently de- 
sired. To convince you of this, you will not require me 
to enter into the secret history of adultery. Many of these 
modest looking doctors, inflamed with thoughts of the 
well-shaped bodies of the women they have delivered, 
handled, hung over for hours, secretly glorying in the 
privilege, have to their patients, as priests to their pe- 
nitents, pressed for accommodation, and driven to adultery 
and madness, where they were thought most innocently 
occupied. In one case, I was well assured, that a physi- 
cian in Charleston, infuriated with the sight of the woman 
he had just delivered, leaped into her bed before she was 
restored to a state of nature. The melancholy tale of the 
seduction of the wife of a member of congress from Caro- 
lina, by her accoucheur, is a warning that ought not to be 
disregarded. The beautiful organization of the lady prey- 
ed on his mind for years : he sought her from one to the 
other extremity of the country, regardless of all dangers ; 
and on acquiring his game, received a premature and vio- 
lent death — leaving horror and ruin in the family he had 
been hired to serve. 

' v natev°r you may think on this subject, there are many 



27 

husbands to whom the idea of their wives' exposure of per- 
son, is horribly distressing. I have heard of cases, afford- 
ing singular mixtures of the ludicrous and distressing. In 
one case in my neighbourhood, the husband sent for his 
physician to his wife in labour, yet was so strongly excited 
at the idea of her exposure, that very solemnly he declared 
to the doctor, he would demolish him if he touched or 
looked at his wife. No man possessed of a correct and 
•delicate regard for his wife, would subject her to any 
exposure to a doctor, that could be avoided without 
danger. 

But the opposition, the detestation of this practice, can- 
not be so great in any husband, as among some women* 
The idea of it has driven some to convulsions and de- 
rangement ; and every one of the least delicacy, feels deep- 
ly humiliated at the exposure. Many of them while in la- 
bour, have been so shocked at the entrance of a man in 
their apartment, as to have all their pains banished. Others, 
to the very last of their senses, suffering the severest tor- 
ments, have rejected the assistance of men. There have 
been many of this description in all ages ! virtuous and 
sainted souls — they preferred dying in all the agonies, 
the throes, and the convulsions of fatal labours I They 
did err on the side of delicate feeling ! but their errors will 
be blotted out for ever ! To be instrumental in relieving 
one of this truly interesting cast, will be a heavenly conso- 
lation to all who can be alive to the pleasure of serving 
the virtuous. 

It requires but a little understanding of this subject, to 
enable you frequently to prove of great service in remov- 
ing the fears and forebodings of many ignorant sufferers, 
who imagine that only professional skill can afford relief. 
Many such objects of commiseration have languished day 



after day, solely from the want of a little information in 
one of the attendants ; all unnecessarily lamenting that 
physicians cannot be procured. By a little information, 
you can at all times prevent the miserable mutilation of mo- 
ther and child, which has frequently been committed in a 
shocking manner, solely from the grossest ignorance. In- 
deed, to be able to say to ignorant widwives, fancying they 
must be doing something continually, " Thou shalt not in- 
terfere — thou shalt not meddle with nature," will alone be 
sufficient to effect essential service. On other occasions, 
and in all parts of the country, sudden labours coming on, 
before proper attendance can be had, you will be able to do 
important good to mother and child. One case of suffer- 
ing of this kind, from want of assistance, in my opinion, is 
a great reflection on the ladies who are convenient for at- 
tendance. Indeed I think it disgraceful, that any female 
should be allowed to grow up in ignorance — in pursuit of 
pleasure, too fancifully nice — so falsely delicate, as not de- 
liberately to get so much knowledge in one hour, as will 
enable her to do, or to direct the unlearned servant, how to 
perform the little offices required on the emergency, to 
which all of them are subject. 

It is not to be disguised, that all classes in the communi- 
ty have to deplore the loss of some friend in child-bed. 
Many are mourning at the loss of amiable wives — victims 
to what ought to have been the subject of their joy. Pa- 
rents are still lamenting the premature death of their 
daughters — buoyed up with the hopes of feeling as mo- 
thers, when the pains of labour were forgotton. Innume- 
rable babes have been sacrificed in the most afflicting man- 
ner ; many of whom may have become ornaments to their 
country. All such calamities may have been prevented, 
if but one lady in the neighbourhood of each case, had 



have devoted but a part of the time spent in guessing about 
the operation, to an accurate knowledge of the subject, so 
that she might have directed the ignorant and meddling 
attendants. It is said the Lord declared he would save 
the city of Sodom if but ten men were found good in 
it ; and surely it is equally certain, that the whole of you 
should attend to this subject, with the prospect, even that 
only ten might be called on to render the needful assist- 
ance. 

Every day shows that the practice of midwifery re- 
quires no particular skill, no superior knowledge, no 
slight of hand, nothing beyond the most common sense 
and observation, to do all that is required with perfect 
success. Nature has so wisely provided for the birth of 
the young, that even the extensive practice so highly rated 
among ladies is not necessary for the discharge of all the 
duties required from attendants. The male practitioners, 
who in general, from accidents, have got into great repute, 
received their first impressions from books, from direc- 
tions which any one in the country can comprehend. The 
increasing applications to these women doctors, remaining 
satisfied with such business, are really made in vain ; for 
most commonly, in qualifications they are not far removed 
from the sisters of the profession. Physicians of the best 
abilities, discovering, that it is by the fingers instead of the 
talents, that many get the most profitable business, attend 
to this subject only in the beginning. An introduction 
into better occupation, excepting in the cases of their fa- 
vourites, is almost invariably followed by an abandonment 
of midwifery ; so that the ladies have often to look out for 
different attendants. 

In some parts of our country, the negro women, feel- 
ing their ignorance, and fearful of hurting their mistresses. 



30 

hesitate in acting, until they accidentally discover the pow-> 
ers of nature ; then they obtain great reputation in the 
practice of widwifery, rivalling the most renowned doc- 
tors of the trade. They soon discover the secret, that 
nature does all the business, and that they have only to 
keep themselves quiet, and pocket the credit of the ope- 
ration. 

During the simplicity of the early ages, women alone 
officiated at births. In Egypt, the cradle of so much sci- 
ence, they were the sole actors. At Athens a law was 
passed forbidding them to practise j but from persever- 
ance among the delicate, preferring death to exposure, the 
law was speedily repealed. Since then no government, 
it is believed, has been so ridiculous as to compel such un- 
natural interference. In consequence, the practice has 
been confined to women, until within a few years, in some 
European countries- and their colonies. The excessive 
spirit for meddling with women is no where so great as 
in France. They are so fond of indulging their curiosity 
at births, that they even attend on the domestic animals in 
labour. Mr. S. told me, that he witnessed the operation 
by a professional character for cows. The cow, dis- 
pleased with his intrusion, made all possible resistance ; 
and when it was over, for hours endeavoured to attack the 
meddler. There is a stronger sense of propriety among 
the northern neighbours of the French. The Danish go- 
vernment, viewing the employment of men midwives in 
natural labour, as highly improper, established schools for 
the instruction of women in the principles of midwifery. 
Several of the German states have imitated the example. 
The American government should establish such institu- 
tions. The legislators in congress would thereby render 
the nation more essential service than they have done for 
vears. 



31 

If the difficulty of obtaining doctors at the proper time ■; 
if the indelicacy and tendency to immorality of having 
them in any but the critical and unnatural cases ; if the 
propriety of giving to helpless women proper encourage- 
ment and support ; if the salvation of many women, who, 
shocked at male interference, have their pains vanished, 
and minds deranged, and who sometimes prefer death to 
exposure ; if the salvation of many children born al- 
most without warning ; if the prevention of the destruc- 
tive interference of ignorant attendants cannot, united, 
induce you to attend to this subject, the mechanical ad- 
vantage between a man's and a delicate woman's hand, 
ought to command your decision, in favour of employing 
and encouraging female assistants. Such is the confined 
organization of the parts for our birth, and such the 
large size of men's hands, that I verily believe as much 
mischief as good has been done by them, as has been 
stated by more extensive observers than myself. I con- 
clude with the remarks, that when professional assistance 
becomes necessary, from unnatural occurrences, the case 
is altogether altered. The exposure is not of parts in a 
natural state, but deranged ; the woman becomes a pa- 
tient for his operation ; is a subject of commiseration ; 
and the solicitude to remove her danger and agonies is 
the only thought a man can have. In such cases, there 
ought not to be the least hesitation in the female to submit 
to examination j there is no indelicacy in it. Religion, 
future usefulness, command that life should be preserved 
at the expense of an hundred such sacrifices. The rule 
that I would prescribe to the females for whom I felt most 
affection and solicitude would be that which I now urge, 
pn no account submit to the interference of men in com- 
mon labour ; do it most readily in the uncommon cases. 



32 

when a nurse under the direction of a physician cannot af- 
ford relief. I will venture to add, that there is not a phy- 
sician, disinterested, of sound sense, who would not ap- 
prove of the rule. The best authors on midwifery decid- 
edly recommend it. 

An acquaintance with the subject of these letters will 
enable you to be of service to more than those in child- 
bearing. The rational treatment of your own peculiar 
disorders, often so injudiciously conducted, the prevention 
and cure of children's complaints, so interesting to every 
woman of extended feeling, are taken into consideration ; 
subjects well worthy of your serious attention. If no 
other benefit can be derived, but that of preventing the 
administration of improper doses, it will not be inconsider- 
able. Many disorders are rivetted in you, and especially 
in children's constitutions, by taking articles contrary to 
the indication for cure. So many of you are inclined to 
quackery, to believe in stories of cures from the prescrip- 
tions of common people, that it is an important point to 
impress on your minds, that our bodies are subject to 
laws, our diseases to be cured according to principles If 
you will seriously believe this, will believe that medicine 
is a rational science, you will increase the respectability of 
the profession, and your own safety, by always selecting 
for your physician the man of sound mind, who reads the 
books of his profession, instead of the pliant, fin cal, 
" lady's doctor." You will discover that your diseases are 
to be prevented and cured ; not by the compounded trash 
of apothecary shops, but chiefly by the rational use of 
what may be termed the family materia medica. Cold 
and heat, in water and in air, bleeding, rest, exercise, me- 
chanical irritation of the skin, an oiled feather to excite 
vomiting, and glysters to excite purging. 



33 



LETTER II. 



Contents. Cleanliness — warm bath — advantages from 
its daily use — cure for rheumatism — nir bath — cold and 
sea bath — local washing — purification of feet — certain 
prevention of colds — purification of arms — great ad- 
vantages of sitting daily in cold water — regular evacu- 
ations — certain cure of costiveness — prevention and cure 
of piles — zvarts — boils — fistulas — excoriations — mouth 
— preservation and extraction of teeth — tooth powder — 
of the skin — preservation of its beauty — means of pre- 
serving general health— softening the hands. 

An attentive observer of mankind has said that all per- 
sons are pleased with the odours escaping from their own 
bodies, while no one likes those from another, of the very 
same nature. Although Dr. Swift defines a cleanly per- 
son, one with nasty ideas, yet we are all most pleased with 
the cleanly ; I mention this, as introductory to some most 
disagreeable, though useful reflections, necessarily contain- 
ed in this letter. 

In order to find out that u heavenly Chloe," may be dis- 
covered by the nose, the smelling powers of a dog, which can 
trace, through an immense crowd, the footsteps of his mas- 
ter, are not necessary. One with very moderate smelling 
powers can perceive the odour of several parts of the 
body, and however agreeable when from one's self, is very 
disgusting when, as is too often shamefully the case, strik- 
ingly perceptible in others. It is a fact, that daily some of 



34 

the finest, most tender excitements of love, are shocked 
away from men and women by the discovery, on a near 
approach, of some of these offensive odours. You are 
spoken of, in the most disgusting manner, particularly by, 
the lower classes of society, on discovering that you may 
be smelt as themselves. Moreover, men of sense really 
consider your virtue as intimately connected with the 
cleanliness of your person and habits. Count Rumford 
remarks, " with what care and attention do the feathered 
race wash themselves, and put their plumage in order ; 
and how perfectly neat, clean, and elegant, do they always 
appear! Among the beasts of the fields, those which are 
the most cleanly, are generally the most gay and cheerful ; 
or are distinguished by a certain air of tranquility and con- 
tentment. So great is the effect of cleanliness upon man, 
that it extends even to his moral character. Virtue never 
dwelt long with filth ; nor do I believe there ever was a 
person scrupulously attentive to cleanliness, who was a 
consummate villain." Indeed, it would be difficult to 
imagine the reason why females were so constituted as 
to become offensive to the nose, unless for the purpose of 
suppressing too ardent devotion in males. One might sup- 
pose, that nature designed this quality as a defensive wea- 
pon ; agreeably to which? I would suggest, to those ap- 
prehending a rape, to insure protection, by rendering 
themselves as disgusting as possible. In every practica- 
ble manner, on the attack of the assailing villain, the body 
may be rendered so offensive, as to subdue the brutal pas- 
sion of the ravisher. Although the liberty of indulging 
in the worst filth be excusable in such cases, yet, in no kind, 
in the slightest degree, is it to be tolerated in decent so- 
ciety. I have always thought it a reflection upon every 
lady in a company, an insult to each member, for one of 



35 

them to be discoverable by means of the nose. It would 
be a moderate punishment, if establishing the rule you 
would invariably strip and scrub, from head to foot, in spite 
of all resistance, every unclean person. Indeed yoii ought 
to consider the purification of your bodies as the more im- 
portant, since it is an unquestionable truth, that the best 
means of doing it, most wonderfully promote health, pre- 
vent and cure several diseases to which you are liable. 
You may be the more disposed to believe this truth, by 
knowing that the diseases of the body are much more un- 
der the controul of those articles nature has abundantly 
supplied around us, than the various mixtures administer- 
ed as physic. Physicians of greatest intelligence will tell 
you, that a correct knowledge of the proper use of the most 
common articles, will avail you more than a knowledge of 
every medicine. You ought, therefore, to correct your 
partiality for dependence upon nauseating doses, from dis- 
tant countries, in preference to the remedies at hand for 
every family. 

One of the greatest mistakes most frequently committed 
by young ladies, is the anointment with perfumes, to sup- 
press the natural*exudations. It is seldom that this does 
more than partially suppress the effluvia, and but for a 
short time : it often does injury, by stimulating the skin to 
diseased action ; and it never fails to suggest to others, 
that the contrivance is resorted to for the suppression of 
stronger fumes. As I positively assure you, that I am ac- 
quainted with superior means of correcting such smells ; 
means which do no possible injury, never fail of success, 
and essentially promote health, you ought certainly to 
abandon the use of all such perfumed compounds, and give 
the prescription a full and fair trial. 

You ought to be apprized, that it is extremely preju- 



36 

dicial for the secretions of the various parts of the body, 
to remain on them. The matter adhering, acts on them 
somewhat as infectious matter to the body, causing the 
secretion of more of the kind. The secretion adhering to 
the surface excludes the air, and stimulates the parts un- 
derneath, which the more rapidly secrete ; in some cases, 
particularly with fat women, to such a degree, as to render 
the atmosphere around them excessively disgusting. The 
remedy for such a state is the same as that for prevention. 
It is not to apply any thing to the part, but to remove, in 
the best possible manner, the matter on the surface, so as 
to allow the contact of cool air, and the insensible evapora- 
tion to go on. 

The best means of removing the filth from the surface 
of the body, consist in the use of an article excessively 
cheap — one of God's greatest blessings to the human fami- 
ly. It does far more than dissolve, cleanse, and purify 
every part ; it prevents and cures several of your serious 
complaints. Considering the vast importance of this in- 
valuable article — how often it has escaped your notice — 
passing it by as beneath attention, I am at a loss how to 
introduce its name. In order to make a deeper impression, 
I wish I could rouse all your faculties at the development 
— that I could extort from you a solemn resolve, that it 
shall be treasured in your remembrance, and daily used 
in unabating ardour. You need not smile at this pomposi- 
ty, in introducing the name of this universal cleanser ; for 
if you had never known of it, and could henceforth be pre- 
vailed on to give it the fullest trial, you would do homage 
to its powers more extravagantly than I could speak of 
them. Hear, then ! and remember, it is hot and cold wa- 
ter freely applied to every part. Doctor Sangrado never 



37 

extolled it half so much as it ought to have been, when sup- 
ported by " soaking and elbow exertion." 

The most effectual means of washing the whole body, is 
to immerse it for a few minutes daily, in warm water, at 
the same time rubbing it with a coarse hair brush, to take 
off the scales and filth of the skin. This entrance in the 
bath will have a most powerful effect indeed, in prolonging 
your lives, and exempting you from disease. I cannot 
say too much in favour of the cleanly, healthy, invigorating 
practice. 

An idea of the vast importance of washing the whole 
skin of the body in a bath, may be formed by adverting to 
the effects of it among the Romans. Physicians were of a 
respectable order in the community, until bathing became 
general. The free use of the bath prevented so many dis- 
orders, ending in such inconsiderable demand for doctors, 
that barbers performed their ordinary duties. 

In like manner, the standing of the medical faculty was 
reduced in France, after the general introduction of the 
bath. The French women are particularly partial to free 
washing ; and in consequence, seldom think of a doctor, 
excepting for the fashionable occasion of an accouchment. 
An American physician who visited Paris for the purpose 
of improvement in his profession, assured me that he had 
often endeavoured in vain, to smell the odours with which 
we are so frequently assailed in this country — sometimes 
among persons in elevated stations. 

The experience of those in our own country, who make 
a daily use of the bath, is just as impressive. They are 
not subject, in general, to half of the disorders afflicting 
those who suffer their skins to remain besmeared and co- 
vered with the exudation from the pores. The females of 
the southern states, who frequently bathe during the sum 



38 

mer, derive great benefit from the operation. The advan- 
tages derived from visiting the water places, unquestion- 
ably depend more on the washing of the skin, than on any 
medical qualities in the water. 

Indeed I think after viewing this subject in the fairest 
light, on account of humanity and pleasure, every person 
ought to be compelled to bathe daily in warm water. The 
means of warming ivater are in the hands of every one, 
without incurring the expense of additional fire. If a 
small excavation be made in the funnel of chimneys, a pot 
may be fixed, around which the smoke passing, will give 
a sufficiency of its heat to make a large quantity of water 
of the requisite warmth. But the plan giving least trouble, 
is that of heating water to scald hogs in the country. It 
is to put stones and old irons into the fire, and when heat- 
ed, to throw them to the bottom of an open mouthed barrel 
of water. Two or three of such bodies can always be kept 
without inconvenience, in every fire-place, and will suffice 
in a few minutes, to make the water of the proper heat. 
As soon as this is done, they can be removed, and the per- 
son sitting in the barrel, will have a most pleasant mode of 
purifying every part. I consider the suggestion of apply- 
ing this mode of warming water for your daily baths, as 
worthy of your remembrance and observance. 

Rheumatism, I ought not to pass over the subject of the 
warm baths, without alluding to its efficacy in preventing 
and curing rheumatism. I do not mean to say it is a cer- 
tain cure, but it is assuredly one of the greatest ever dis- 
covered. In an extensive ward of a large hospital, I have 
seen it the only prescription ; and only a few were not 
relieved by it — these few essentially benefited. The wa- 
ter should be very warm, and the patient remain in it from 
30 minutes to 2 hours, having his skin well rubbed during 



39 

the time. On coming out, the part affected should be co- 
vered with finely carded cotton, which has been found re- 
markably efficacious in relieving the pains of long standing 
rheumatism. Flannel bandages passed around the affect- 
ed limb, have been also found efficacious in this disease. 

Air Bath, Dr. Franklin discovered that our health was 
considerably promoted Dy exposing our persons naked 
every morning to cold air for a few minutes, and then re- 
turning to bed a little while before dressing. This ex- 
posure to air favours evaporation from our skin, and has 
considerable effect, therefore, in cleansing the body, in- 
creased by the glow, or sense of heat felt on the surface, 
which promotes the evaporation, while it tends to prevent 
internal disorders. Much good would result from its 
universal observance. 

Cold and Salt Bath. The use of the cold bath every 
morning could not fail to answer the purpose of promot- 
ing health, more effectually than the air bath. Persons 
generally suppose a great deal of water is necessary to be 
poured on the body, but it is a mistake. The object is to 
shock the system, so as to rouse action on the surface ; 
and a quarc of water splashed on the back suddenly, and 
running around the body and down the legs, will answer 
all the purpose. Instead of the ordinary preparations, 
to stand on the hearth, and some one, (or one's self can do 
it) to turn over on the back the water in a basin or cup, is 
all that is necessary. When it is desired to use the sea 
bath, you can always have it by adding half a pint of salt to 
half a gallon of water. The salt assists in stimulating the 
skin ; and is such a powerful remedy, that it will much 
more certainly cure periodical diseases, as intermittent 
fever, than Peruvian bark. It gives such vigour, is so 
cheap, that it should be used daily in every family. As I 
shall frequently prescribe this mixture, I wish it to be re- 



40 

membered under the name of the salt bath. The substi- 
tute for general bathing is local washing ; and I com- 
mence with the feet. 

In some persons they are so disgusting, as to be into- 
lerable ; and persons taking up the idea that it is natural, 
give themselves no trouble about purification, unless it be 
now and then to make them worse, by putting some per- 
fume on them. But there is nothing more certain, than 
that the smell may always be prevented, by constant daily 
washing in soap and water. They should be rubbed and 
scraped hard. It is proper to guard against wearing old 
shoes, as old leather increases the odour. 

Before I pass over the subject of the feet, I wish to 
communicate to you a real discovery by an old woman, 
for preventing the colds or catarrhs, which annoy so 
many of us. It is, every morning before dressing, to 
dip the feet in a basin of fresh cold water, to wipe 
them immediately, and return them to bed for a little 
while. A glow will be felt, which is a proof of the 
determination of blood to the part ; a determination, 
which will prevent your receiving colds one tenth as often 
as you have had, or otherwise might have. The practice 
can do you no possible harm ; and I entreat you to ob- 
serve it, because I am positive, that in addition to the 
cleanliness of the practice, it will shield you from many 
attacks, probably even from those that might end in con- 
sumptions. The best remedy for colds is to toast, to 
scorch the feet every night for an hour or two before go- 
ing to bed. 

The smell of the arms is another point to which 
more attention should be paid than generally is. Per- 
fumes do here no good. It is water and soap, hard 
scrubbing, that purifies this region. An idea has been 
entertained among many, that this is naturally in some 



41 

cases too strong to be relieved by washing. But it is a 
mistake. I declare, that there is no case in which the 
arm pit cannot be made perfectly mild in its smell, by 
daily rubbing with soap and a wet cloth. Lime water is a 
species of lye, and has been preferred by many. "When 
the hair under the arm has been allowed to remain as it 
were matted in the secretion of the part, the more persever- 
ance will be necessary. Among those who smell so very 
rank, I would advise the cutting off the hair in the be- 
ginning, so that the daily washing may be more effectual 
in cleansing the skin. I conclude this subject with the re- 
mark, that, considering the certainty with which ladies can 
relieve themselves from this smell in the way pointed out, 
there is some excuse for the frequency with which they 
are laughed at by their male attendants, for the puffs in- 
haled from the arms. 

The next subject for which I have to request your at- 
tention, is the most disagreeable, but it is best to state it 
plainly at once ; it is the smell peculiar to the posteriors 
and the adjacent parts. The large quantities of fat in 
this region with the numerous glands, tend to keep up a 
constant profuse secretion of strong smelling matter, es- 
pecially after walking, the most disgusting that comes from 
our bodies. I have heard some ladies more condemned 
for neglecting to free themselves from this effluvia?, than 
for any other negligence. Some of them really have in- 
dulged in it so long, as not only to appear partial to it, but 
to fancy that others must have the same relish. I once 
knew a physician refuse continuing his visits to a fat lady 
of wealth, because of the excessive disgust this smell, 
arising solely from her laziness, gave him. I hope you 
will pay the more attention to what I have to urge for 
keeping these parts clean and inodorous, as truly the 



4S 

means will have a powerful tendency to establish and pre- 
serve your health, since the parts are intimately connected 
with the general system. 

The great secret for cleansing, and exempting these 
parts from disease, is, ladies, do pray remember it, to sit 
night and morning in a tub or piggin of cold water, with 
or without soap ; and for lour or five minutes splash and 
rub the water around. I feel my want of powers to im- 
press the importance of the observance of this practice. 
The prescription should be observed from the oldest to the 
youngest, male and female. The posteriors of most animals 
are naked ; so that, what is secreted is speedily evaporated, 
with the consequence of their total exemption from dis- 
order. Children frequently throwing up their clothes, so 
as to ventilate themselves fully, have but few complaints 
of these parts, and it is certain with us, they would be 
more healthy, if more exposed to cold air. The substi- 
tute for this exposure is cold washing. The matter se- 
creted around is dissolved, and goes off with the water, 
leaving the air to take off what is afterwards formed in 
imperceptible evaporation ; while the tone of the parts 
becomes so improved, the action of the vessels so lessen- 
ed by the cold, that the quantity and quality of the secre- 
tion cease to be subjects of attention. 

If I can but prevail on those of you who can get pig- 
gins and all who cannot procure them, to go daily at the 
edge of a brook, and to sit in cold water for a few minutes, 
I shall render you more real service than I could by en- 
abling you to double your fortunes. Indeed, this fre- 
quent washing in cold water will prevent your having that 
distressing complaint, called the piles, as also any kind of 
boils, fistulas, or inflammations of these parts. Another 
great and important advantage of the practice, is the tak- 



ing away from the birth place, the secretion of the ad- 
joining glands, which is apt to become acrid and offensive; 
and then irritate and excite the external sources of sexual 
feeling. There is no doubt, but that such irritation is the 
cause of premature desires, prostitution, hysterical affec- 
tions, and diminished growth of the body. As all ani- 
mals have their growth diminished by such excitements ; 
mothers ought to guard their daughters not only against 
this, but too early hugging, toying and amorous conversa- 
tion, which produce the like action. The practice of this 
cold washing, at least at night, will prove so highly advan- 
tageous, that I cannot avoid feeling anxious to induce you, 
universally to do it. As soon as you get in the habit of 
it you will find it no trouble, a source of far more agreea- 
ble feeling at the time, than washing the face and hands. 
I beseech you to entreat all your acquaintances, to direct 
all your servants to follow the advice. 

While on this subject, as of equal importance, I would 
earnestly recommend the visiting daily the necessary at the 
same hour ; never going before or after the fixed hour, 
unless disease exists. You have heard of great effects pro- 
ceeding from inconsiderable causes, and this case affords 
an instance. The diseases brought on by the supposed 
trifling cause of retaining the contents of the bowels, are 
great indeed. The retention by the bulk of the matter, 
produces irritation in the surrounding parts, marked by 
piles and boils : next, the matter which should be discharg- 
ed ferments, generates large quantities of foul air, which 
passing through the bowels, stimulates to diseased action, 
as any other fumes introduced would certainly do. You 
will readily admit this, if you will advert to the difference 
in quality and quantity of the wind escaping from the bow- 
els, when the contents are long retained, or speedily dis- 



44 

charged, as often exemplified in children. Most of the 
cases of colic and indigestion, arise from this cause : also 
frequently dysentery, and all the diseases arising from 
parts sympathizing with those affected. 

The habit of evacuating the bowels, may be acquired by 
every one who will take the pains to attend to the means ; 
and this will insure a total exemption from the distressing 
costiveness of which so many complain. Our systems 
have been called a bundle of habits : they are perpetually 
inclined to do one day, what they did the day before. You 
must have observed the remarkable regularity in the re- 
turns of appetite, thirst, sleep, agues, bleedings, and the like 
periodical excitements. My object is to prevail on you to 
avail yourselves of this tendency of the system, to establish 
this habit, to let nothing prevent you from attending to it 
afterwards. In the beginning, efforts will be necessary ; 
you must be accurate in observing the hour, never going 
before or after it, unless you are diseased. In obstinate 
eases, you should use what is called the " sailor's remedy;" 
which is, to push up the fundament a piece of hard soap, 
shaped as the little finger, and hold it there until the eva- 
cuation comes on. A similar cut piece of wood, with a 
soaped or greased rag around it, will answer, as also the 
oiled finger. By persevering in such attempts, the habit 
will soon be fixed, and it will remind you of the approach 
of the hour without fail. Again I beseech you to perse- 
vere in the attempt, although disappointed in the beginning. 
The advantages resulting, would compensate far greater 
labour. If you fully knew the enormous quantities of 
physic swallowed for correcting costiveness, the variety of 
diseases brought on by retaining the decomposing contents 
of the bowels, you would not require again to be told of 
this certain remedy. I will add, the efforts had better be 



45 

made in a necessary open at bottom, for the cool air, on the 
principle of Dr. Franklin's air-bath, before described, will 
evaporate the moisture of the parts, and rouse to a new ac- 
tion and determination. This will be infinitely more saluta- 
ry, as it is more cleanly, than the lazy, disgusting habit of 
some women who use pots in their rooms* 

Piles. This presents itself as a proper place to state what 
should be generally understood on the subject of the piles* 
It is a disease which almost every one has at times, varying in 
degree : from moderate inflammation of the fundament, to 
the formation of tumours. In the beginning, the anus and 
its edges, have their sensibility greatly increased ; there is 
a sense of soreness, a feel as if innumerable sharp points 
were perforating the parts. There is generally an increase 
of the secretion of the mucus of the part, erroneously sup- 
posed the cause of the complaint, as its seat is in the hard 
parts, the fibres and vessels. Sometimes the inflammation 
increases considerably, as does the swelling ; which often 
terminates in tumours of a dark colour, which bursting, 
discharge a dark blood, that affords present relief, At 
other times^ the pain extends up the gut, constituting what 
is called the blind piles. The disease is apt to be attend- 
ed with fever, and to return at intervals. 

The prevention of this loathsome disease is ensured, as 
certainly as that you exist, by daily washing the fundament 
in cold water, especially after every evacuation from the 
bowels. When, from riding or walking, there appears to 
be an increased feeling in the part, there should be an im- 
mediate resort to the use of water. I never knew or heard 
of one person who ever had the piles, who took the trouble 
of using this cleanly ablution. 

The cure of piles may generally be effected by the hour- 
ly application of cold water, made more so by ice, particii- 



16 

larly if aided by abstinence in eating and drinking, and 
rest. When the disease is considerable, it is best to apply 
a solution of sugar of lead, a tea spoonful to the pint of 
water, and to keep a rag wet with it constantly on the in- 
flamed parts. I have seen the most distressing cases of it 
cured by cold water alone, much sooner than by the old 
modes, with nut galls, alum and supposed astringents. In 
cases attended with fever, you should bleed, and purge 
with salts, oil, or calomel, to be repeated until the fever 
and inflammation subside. 

When the pain is violent, in addition to the iced and 
lead water, sweet oil should be applied : mild mercurial 
ointment is also proper. When the pain is up in the bow- 
els, more evacuations are proper than in the other cases ; 
but above all, inject freelv, every hour or two, cold water. 
If the pain be great, add two grains of sugar of lead to each 
injection. Proper attention to this may save vou from the 
most miserable condition that disease can bring you to. 

Warts. The parts about the fundament are very subject 
to warts or tumours, particularly among those who do not 
sit daily in cold water. W r hen they grow to any consider- 
able size, it is best to tie a small string tightly round each 
at its origin, or to cut them off with a sharp pair of scissors. 
As there is no danger in the operation, (though painful,^ 
any one may perform it. The parts should be bathed in 
lead water, as above, after the operation, and mild mercuri- 
al ointment applied to the sores until cured. Free wash- 
ing will prevent the recurrence of these tumours. 

Boils and Fistulas. No part of the system is so subject 
to inflammation as the fundament ; and when inflamed, to 
degenerate into fistulas, which are running sores through 
long inflamed passages or canals, formed for the passage of 
matter. The number of men and women who dailv die in 



47 

the United States, from neglecting these affections at their 
commencement, is in reality almost incredible, and should 
be a warning to you to avoid the like evil. I would have 
every female aifected with the slightest inflammation in this 
part, to have before her view, until the cure be completed, 
the most distressing termination, in order that in good 
earnest she may attend to the subject. 

These inflammations are certainly to be prevented by 
frequent washing in cold water, and daily evacuating the 
bowels. 

The cure is to be effected by cold applications. An 
hourly application of the coldest water of ice, with abste- 
mious diet, and perfecf *rest, will be sufficient to relieve 
lesser degrees of these affections. But when these reme- 
dies have been neglected, or when the inflammation still 
increases, the patient should be blooded freely, should be 
cupped near the part, to which leeches should be applied j 
immediately after, rags wet with lead water should be ap- 
plied, and removed every hour or two. If this do not 
prevent the boil from forming matter, (called coming 1 to a 
head, or suppuration) then a poultice may be kept on it, of 
any oily moist article. The moment the matter appears 
to be formed, and coming to a point, it should be lanced, 
cut straight in the direction to the anus, the orifice just 
large enough to allow the passage of the matter. The 
lancet may safely go half an inch deep : needles have been 
used for these boils by women, when the matter appears 
to be near the surface. The best instrument, giving least 
pain, is the common spring lancet, for opening all boils. 
After the opening, and the. passage of the matter, a poul- 
tice of milk and bread should be applied ; I have used 
these made w r et with lead water, with advantage. It is by 
subduing the inflammation of these boils, by evacuations 



48 

and cold applications, remedies which the most ignorant 
can resort to with safety, that the formation of fistulas is 
prevented. The cold applications are to be continued 
some time after the cure, to prevent returns, to which the 
parts are generally much disposed. 

When the fistula is but slight, it will be practicable for 
a woman to cut it open, particularly if instructed by a 
physician. The dressings should be simply oiled lint, to 
keep the external parts open till the bottom heals up. In 
other cases, surgeons must inspect and operate ; but the 
necessity will seldom exist, if attention be paid to the pre- 
vention, 

Excoriations. Those taking much exercise, by walking 
or riding, are very apt to have their skin rubbed off, par- 
ticularly about the thighs. The best remedy I have ever 
seen tried is cold water. It is proper after washing to ap- 
ply some oily substance ; tallow or hogs' lard answers very 
well. The moment one feeis any part increasing in sensi- 
bility, the cold water should be applied as a preventive. 

Teeth. The last point which I shall with solicitude 
press upon you, is the purification of the teeth and mouth. 

If possible, this is more all important for your general 
health, than cleansing any other part. To the scripture, 
that " out of the mouth cometh forth evils," might have 
been added with equal truth, u in it are engendered many." 
It is inconceivable how greatly the whole system is affect- 
ed, sometimes inflamed, by the mouth. You must have 
witnessed, that a small quantity of spirit held in the mouth 
of a sick person invigorates the whole body. A disgust- 
ing mouthful frequently excites vomiting in persons not 
very delicate ; and diseases of the mouth almost univer- 
sally produce serious effects in other parts of the body. 

This being the case, as it assuredly is, does it not appear 



49 

strange that so many ladies escape sickness and death? 
who, neglecting their mouths, have the most disgusting 
matter perpetually generating between their teeth, and car- 
ried down to the stomach, there acting as a slow poison in 
the excitement of innumerable disorders ? It is with the 
utmost pleasure that I am enabled to say to you, the evils 
from this source may be prevented entirely ; that you may 
all have what all want, a pure sweet breath, as it is called, 
however defective your teeth, by the means contributing 
to feelings of pleasure. 

After all the researches of doctors, quacks, and ladies, 
for the best dentririce ; after the use for centuries of sim- 
ples and compounds, hazarding the destruction of all, and 
ruining many teeth ; after all the inventions of tooth- 
brushes, stiff, soft, then with sponge, the great discovery 
has at last been made, that the best possible application to 
the teeth and gums, is an article very cheap, endangering 
nothing, purifying the mouth, by bringing out the offen- 
sive matter formed in it ; which important article is com- 
monly called warm water ! 

The preservation of the teeth depends most on the pu- 
rification of the mouth. In order to purify the mouth 
and teeth effectually, they must be washed in warm water 
morning and night, besides regularly after eating. The 
water should be taken into the mouth, the lips held tight, 
and then freely and strongly agitated by working the jaws 
and tongue, so that the effects shall be felt on the gums, 
and the glands of the mouth, as well as on the teeth. No 
tooth-brush is necessary, the finger answers sufficiently for 
rubbing ; but if you will have a tooth-brush, let it be of the 
softest kind you can procure ; a piece of sponge tied at 
the end of a stick, answers very well ; as does a clean 



50 

linen rag. Nothing can be more destructive to gums and 
teeth than a stiff hair brush. 

There is but one tooth-powder I would ever consent to 
be used. This is vegetable matter, as crust of bread, or 
common coal, burnt well, and reduced to fine pbwder. 
Objections have been made to it, from the fear of darken- 
ing the teeth, which are entirely groundless ; as the teeth 
are only darkened when their covering, called enamel, is 
rubbed away in consequence of the folly of using cor- 
rosives and hard brushes. Charcoal has a powerful effect 
in resisting the putrefaction of all the matter between 
the teeth. Those who fancy there .are better powders, 
may be allowed to tr> powdered chalk, soap and water, 
also, Armenian bole and Peruvian bark ; but they should 
be absolutely prohibited from the use of acids, salts, or 
any active article. Remember, that the enamel of the 
teeth once destroyed, can never be restored. 

When the teeth, from long neglect, become incrusted 
w T ith a dark yellowish looking matter called tartar, this 
ought to be scraped off with a pen-knife, very slowly. 
There are little scrapers made for the purpose, answering 
with more convenience. Only the parts of the teeth 
that have on them the tartar, or foreign substance, ought 
to be scraped ; so that the sound parts will not be injured, 
as they always are, when hard brushes and active ar- 
ticles are used to wear off, and to dissolve the incrusta- 
tion. 

In cases where the teeth are " rottening," in order to 
prevent the disagreeable taint they give to the breath, it is 
best to push in them a small particle of charcoal. Where 
the hollow of the tooth is considerable, after putting in a 
little charcoal, there ought to be a small piece of bees' wax 
■pressed over it, to remain as a plug. The facility with 



51 

which this plug may be removed is a great convenience, 
as it enables you to take out at pleasure any matter which 
may be formed underneath. 

There are cases where the enamel of the teeth being- 
broken off by some violent operation (nut cracking) a plug- 
more permanent than wax is necessary. In such cases, a 
dentist should be employed to insert a plug of gold to 
exclude permanently from the root of the tooth, the air, 
saliva, and whatever else may be put in the mouth. 

But where the teeth are actually decaying ; and in 
cases where defective roots of teeth, called stumps, re- 
main in the sockets, excepting with pregnant women, 
they should in every case be extracted ; more especially ia 
those cases where the health is delicate. The neglect to 
do it, has been the cause of the disease and death of mil- 
lions. I before hinted at the connection between the 
mouth and the general system. You perceive that chil- 
dren, teething, have a great variety of disorders in conse- 
quence of the irritation in their mouths. This connec- 
tion or sympathy between the mouth and other parts, will 
appear the more striking, from the facts respecting the 
transplanting of teeth, which was formerly done frequent- 
ly. Those who underwent the operation of transplanting 
were very often subject to diseases almost precisely like 
those of the venereal nature. They had enlargements of 
the bones, deep ulcerations, and were cured, for a short 
while, by mercury, which induced the belief that they 
were of the venereal kind. This led to the greatest cau- 
tion in the selection of the person to supply the teeth ; 
neveVtheless, the same consequences ensued. At last it 
was discovered, that the cause of the complaints was the 
irritation kept up in the sockets of the teeth, by the foreign 



m 

tooth inserted ; which, of course, led to the abandonment 
of the practice, and substitution of artificial teeth resting 
on the gums. Now, what I wish you to remember con- 
stantly is, that decayed teeth in the gums produce pre- 
cisely the same effects ; enlargement of bones, ulcera- 
tions, bowel complaints, and many other disorders, de- 
pending on the particular sympathies of each person. 

But few physicians ever think of this subject. It was 
very early and very forcibly impressed on my mind by 
two or three cases clearly establishing its importance. In 
one instance an elderly gentleman, repeatedly salivated for 
a supposed venereal taint, sent for me, and on my prescrip- 
tion, " take out every defective tooth," he laughed hear- 
tily ; at length I prevailed on him to follow the advice, and 
a perfect recovery made him a warm convert to extracting 
rotten teeth. Deafness has been often produced by decay- 
ed teeth in the sockets, and often relieved by their ex- 
traction. 

Whether you comprehend the reasoning or not, on the 
subject, you will save yourselves from many tormenting 
affections by following the advice. Indeed, I am so po- 
sitive of the great advantages which will result from it, 
that you will be fully paid for the trouble of a year's study, 
if you will but remember to compel your doctors to ex- 
tract your decayed teeth, at least whenever you have any 
serious complaint. It will at all events be of essential 
service in lessening the irritation in your systems, inclin- 
ing them to fever. It will have a great tendency to pre- 
vent the adjoining teeth from decaying ; especially if, in 
addition, you will keep the mouth well cleansed with warm 
water, particularly after eating, and sleeping, without in- 
juring the gums. 



53 

Tooth-ache. Before dismissing the subject of teeth, it 
will be proper to make some remarks on the tooth-ache, to 
which so many females are liable. The general impres- 
sion, that this disease is confined to the part affected, is 
erroneous, in almost every case ; the system is in an in- 
flammatory state, and requires bleeding and purging. In 
all cases, except pregnancy, where the tooth is hollow, it 
is best to extract it. If this be declined, relief may often 
be obtained, by putting into the hollow of the tooth a 
small piece of opium, or camphor, or particles of sugar of 
lead, or a drop or two of oil of cloves ; the gums should 
always be cut. When the mouth is inflamed, or the 
cheeks swelled, I would advise a warm solution of sugar 
of lead (a tea spoonful of lead to half a pint of water) to 
be held in the mouth for some time, care being taken not 
to swallow it, and afterwards to wash the mouth with 
warm water ; to be repeated every two or three hours. 
A mustard plaster, and also cupping behind the ear, or on 
the neck, have afforded relief; as also cloths dipped in 
hot water, or in vinegar and water, or in brandy and water, 
applied round the cheek and neck. A blister plaster on 
the cheek for an hour or two, to irritate the surface, and 
divert the action from within, is very good ; in cases of 
long standing, the blisters may be allowed to rise, and 
discharge for a few days. Those who have sound teeth, 
ought not to have them extracted for the tooth-ache ; be- 
cause, generally, the next or an opposite tooth becomes 
equally pained ; so that some have, without any good ef- 
fect, had all their teeth extracted. In these cases, it is pro- 
per to pay great attention to lessening the inflammation of 
the system ; and to diverting action from the part, by cup- 
ping and blisters externally, with a solution of lead wa- 
ter within the mouth. Sometimes, a solution of alum, als© 

TI 



34 

of white vitriol, held in the mouth in like manner, have 
lessened the inflammation causing the pain. 

Of the Skin, Having said so much on very disagreea- 
ble subjects, I proceed to m.ike a few remarks on the mode 
of beautifying your skin. This is a subject which has 
attracted so much attention, that I believe, if all the money 
could be collected which has been expended for the object 
as well as in payment of physicians, for curing diseases 
brought on by improper applications, from buttermilk fill- 
ed with maggots to mineral poisons, it would be sufficient 
to support all the poor people in every country. All the ex- 
pense and trouble too have been encountered to no purpose; 
both women and apothecaries having lost sight of the fact, 
that the state of the skin depends on the state of the bodyj 
that to make it look well, you must make the body healthy. 

The great receipt for making the skin look well, is, ob- 
serve a regular diet of very mild articles, refraining from 
strong tea, spices, pickles, and all that is pungent, as from 
intoxicating liquors. Regularly evacuate the bowels, and 
sit in cold water ; pour a quart of water over your bodies 
every morning, go into the warm bath every night ; take 
more exercise out of doors than you are in the habit of 
taking in the house ; adapt your clothing to the changes of 
the weather ; guard against exposure to a hot sun, with 
as much regularity as you observe among the horses and 
cows, that appear to know its poisonous effects upon ani- 
mal bodies. Especially sleep in rooms admitting fresh 
air through doors, chimneys, and cracks, but never have 
the windows opened at night. I wish to press the observ- 
ance of this the more, as I know the obstinacy with which 
some insist on having them open. Occasional escapes 
from violent pains in these show no more the propriety of 
the practice, than of a man's living thirty years, daily get- 



55 

ting drunk, shows that it is healthy to get drunk. I am 
positive, that, on the average, one half of the fevers of our 
climate arise from exposure to night air. Our systems can 
do well in any extreme, but not in any changes. The air 
of the day is dry, that of the night is humid ; at night, too, 
our bodies, having less action, are less capable of resisting 
disease. You have observed that a current of wind on 
the neck at night produces the wry-neck ; how much great- 
er must be the effects on the constitution ? The habit of 
sleeping with your windows down will soon be found 
as agreeable as the reverse ; for the air entering at an 
open door, and through chimneys and cracks, will be fully 
sufficient for perfect respiration. By adhering to these 
rules, rely upon it, you will be rewarded, not only with a 
beautiful healthy skin, but long life, and exemption from, 
many diseases. 1 warn you never to endeavour to im- 
prove your skin, by using, in any shape or manner, the 
poisonous metallic preparations of lead, mercury, and 
arsenic. 

It is indispensably necessary to shield the face and arms 
from the sun and a current of air to prevent them from 
being discoloured by light. But in screening from this, 
it is improper, to cover so as to oppress, and, conse- 
quently, excite disease by the great heat retained. The 
best covering is that which is thinnest, and least pervious 
to light. If covers could be had of any metallic body, 
as silver or steel, they would answer best. 

The only means of softening the skin consist in oiling it 
well with sweet oil, at least, on going to bed. Gloves and 
leather for the neck, oiled and worn at night, are proper for 
this object. In those countries where large quantities of 
sweet oil are made, the women apply it freely, and have 
remarkably soft skins. 



56 

To prevent and cure the pimples on the forehead and 
face, it is proper to wash frequently in cold water. A 
weak solution of sugar of lead, applied every night to 
them, would be of service, if aided by exciting action in 
the lower extremities. Married women have them not ; 
and those who are single would escape them, if they would 
excite a determination to the lower extremities by walk- 
ing, riding on horseback, jumping the rope, rubbing the 
skin of the extremities, and about the same time washing 
the face in cold water, or a weak solution of lead. Sweet 
oil, rubbed over the pimples, has also a powerful effect in 
preventing their return, if aided by the other means men- 
tioned. I suppose it will be useless to make any remarks 
upon the old fashioned, ridiculous notion, that the face and 
hands of ladies ought not to be washed in cold water, 

I conclude this letter with the remark, that if I have 
said enough to induce you to do three things ; first, to 
sit daily in a tub of cold water, if not, bathe in the eco- 
nomical manner suggested ; secondly, at the same time 
daily evacuate your bowels ; and thirdly, to wash your 
mouth in warm water, and have your decayed and stumps 
of teeth speedily removed, I shall have rendered you 
most essential good. I pray God, that you may not be 
satisfied until you have a full and fair trial of what so 
earnestly I entreat you to do. Make the experiment, and 
the moment yqu perceive the advantages which I know 
will follow, then I beseech you to impress it on all th,e 
uninformed coming under your notice. 



57 



LETTER III. 



Contents. Principles of life — of disease — of cures — cir- 
culation of blood — secretion — use of fat — starvation — 
sympathies. 

An essential part of the education of every male and fe* 
male, in my opinion, should be a general knowledge of the 
outlines of the nature of their bodies, and the principles of 
the cure of their disorders. Not for the purpose of prac- 
tising physic, but to enlarge the mind ; to habituate it to 
think rationally on the subject, and to guard against the 
innumerable impositions of the quacks, as well those who 
advertise as such, as those of vast boasting experience — de- 
ceptious only to the ignorant. Had but the slightest know- 
ledge been cultivated on these points, the world would 
never have been pestered with the innumerable and pre- 
posterous accounts of doses " for thinning the blood, for cor- 
recting the" bile, for purifying the urine, for dispersing tu- 
mours," and for the like ridiculous objects. It is well 
known how greatly the science of chemistry has improved 
since the introduction of proper names ; and the same 
would take place in medicine, if the same accuracy were 
observed. Most of the improvements in medicine were 
discovered by the common people ; and how much greater 
these must haveHbeen, had they understood the principles 
of the science. The persons feeling the disorders must 
more accurately describe their varying stages, and the ef- 
fect of medicines, than their attendants can possibly do. 



58 

Although I cannot pretend to give such a full view of 
the subject as might be best for you, I will proceed to 
sketch some of the outlines which ought to be remem- 
bered. 

On viewing the body, nothing is so obvious as that all 
the animated parts are composed of innumerable fibres, or 
small particles, which, being endowed with the power of 
contraction, cause all the actions, voluntary and iuvolunta- 
ry, in our systems. 

Our bodies grow, and are supported by the food taken 
into the stomach. The food excites in the stomach the se- 
cretion of a solvent called gastric juice ; which is adapted 
to the solutions of the article taken into the stomach, when 
the stomach is habituated to it. But not so when it is not: 
thus stomachs accustomed to meat alone, will not dissolve 
vegetables, and the reverse, unless the changes are very 
gradually made, from one kind of diet to another. Hence 
the propriety of our changing diet by degrees. When the 
food is dissolved in the liquid of the stomach, it is carried 
along the bowels, and there absorbed, forming chyle, which 
is carried into a large duct, which empties it into a vein ; 
when, mixing with the blood, it circulates over the system, 
and soon becomes blood, the article which our bodies re- 
quire for every purpose. 

The blood into which our food is so converted circu- 
lates or passes through every part cf the body, and supplies 
to each part matter for its formation and existence. The 
circulation of the blood is as follows : — there are vessels, 
called veins, in all parts of the body, which, uniting, carry 
the blood to the right side of the heart, when the heart 
contracts, with wonderful power, and throws it into four 
large arteries, which convey it to the lungs ; and then di- 
viding into innumerable small branches, spread all over the 



59 t 

interstices or cells. In the lungs, the blood receives somt 
vital substance from the air, and gives out its useless parts 
— the whole process is called respiration. After it under- 
goes this respiration in the lungs, which gives it a very 
florid appearance, it is collected in small veins, gradually 
uniting, till they form four large veins, which go directly to 
the left side of the heart ; here the heart contracts, and 
throws the blood into a large artery, which, dividing, and 
going all over the body, supplies every part with what is 
wanted ; and then it passes of a dark colour to the veins ; 
and thence as at first stated, repeating the course. The 
stroke of the heart for propelling the blood over the bo- 
dy, as you will find by feeling the pulse, is in an infant 
about 120 the minute, of 5 years is 100, of 20 years 80, of 
50 years 60, of 90 years 55. This action is subject to great 
irregularity. Thus, you perceive, the pulsation of the ar- 
teries is derived from the heart- — that the blood is purified in 
the lungs by our breathing, and constaatly thrown over the 
body for its various purposes. This, termed the cireula- 
lation of the blood, you will find explained in detail in the 
books of anatomy ; it wonderfully displays the wisdom and 
care with which nature has made our bodies. 

It is the union of the little fibres that constitute what is 
called flesh, or muscles. These fibres possess the capabili- 
ty of contraction, and this is called irritability, or suscepti- 
bility, or excitability ; by which words you are simply to 
understand, capability of action. It is on this susceptibili- 
ty of action that animal life depends. The causes or 
things which operate on it, are called stimulants ; and the 
action throughout the system is called excitement. Thus 
you have an abstract of the beautiful, sublime, and simple 
theory of animal life, as explained by the great Dr. Brown 
of Edinburgh. Our bodies have capability of action, call- 



60 

ed excitability ; and stimulants operate on it, producing 
the various excitements of life. 

For health to exist, excitement and excitability must be 
equal ; in proportion to the difference between the two is 
disease. 

Diseases, general or local, of high excitement, are what 
we call inflammatory, marked by all the symptoms of in- 
flammation, or high action, For their cure, of course, they 
require reduction of the excitement,by perfect rest, by cold, 
blood letting, and by other evacuations, as purges, eme- 
tics, and the like. All things, in these cases, which sti- 
mulate without producing evacuation's, must of course be 
injurious. 

Diseases, general or local, of low excitement, are called 
nervous, or typhus, and are marked by low, weak pulse, 
&c. For their cure, stimulants are proper, as brandy, 
wine, bark, &c. All things which reduce or weaken 
must of course be injurious. 

This is the outline of the theory of diseases of our 
body, from which you will perceive, that the practice 
of physic is reduced to the simple points of ascertaining 
what kind of action exists in a person, and what remedies 
of the nature called for, are best for each particular case. 

Now as every disease may, at different times, take on 
these two opposite actions, high or low, it follows, that the 
treatment of the same disorder which will cure in one 
stage will destroy in another I Thus fall, ladies, all the 
stories of " a certain cure," in any one article, for there 
can be no one cure for any one disease. If you be- 
lieve I have not deliberately deceived you in stating the 
great principles of life and disease, you must cease with 
your credulity, almost universally believing in the state- 
ments of special cures by special mixtures. No more cor- 



61 

recting, blood sweetening doses ! You will perceive, that 
such secretions are the result of the diseased actions of the 
fibres ; that cures are to be effected through the solids, the 
fibres, the active parts, not the fluids without capacity or 
power of action. For example, in what is called bilious 
fever, you give an emetic, not to throw off the bile, but 
to raise the fibres to a new healthy action. 

The principle on which cures of disordered parts are 
effected, has been a subject of great inquiry, though not 
yet explained as we could desire. There are, however, 
several doctrines which ought to be understood. 

When a diseased action exists, and we suspend it by 
any means, the tendency of the body is, not to go back to 
that action, but to its healthy action. Thus bleeding and 
cold, or any thing raising the system to a new action, so 
as to suspend the diseased action, the body, from its own 
nature, returns to its healthy state. 

When a diseased action exists in some central part, the 
excitement of disease on the surface relieves that within. 
Thus, blisters on the side, for inflammations within ; is- 
sues, whipping, irritations of the skin, &c. operate in re- 
lieving disorders. 

In other cases where disordered action exists, it is oc- 
casionally cured by that which excites and keeps up for 
some time a stronger action in the body. Thus mercu- 
ry, laudanum, and any thing highly stimulating, produces 
so much action in cases of the venereal disease, as to over- 
come the diseased action. 

The modes of curing according to these rules, can only 
be understood by those devoting great attention to the 
practice of physic. The consideration inducing me to 
state them here is, that you may the more readily admit, 
that a strong, sound mind is indispensably necessary for 



62 

the successful application of principles to practice. Hence 
you must infer, that no doctors you employ can be good 
who have not extensive, observing minds. A little ex- 
perience, with a thorough knowledge of theory, are the 
indispensable requisites for successful practice. 

The formation of the various parts of the body pre- 
sents to the rational mind one of the most curious sub- 
jects of inquiry. There have been various theories on the 
subject. At one time it was supposed to be by filtration, 
the solids only acting as strainers to let out such parts as 
were not wanted. The theory that succeeded to this was, 
that the vessels of each part took on a peculiar action, by 
which action the substance, whether for one of the secre- 
tions, or for the growth of the body, was formed. Seeing 
that these explanations were not satisfactory, I accounted 
for the secretions in my inaugural essay in a different man- 
ner, which, the more I consider, appears the more cor- 
rect. This theory is, that the compound fluids of the 
body entering in different parts, variously formed under 
various circumstances of minute division, action, heat, and 
electricity, assume, according to their inherent nature, 
termed affinities, the respective shape and qualities pecu- 
liar to such part. Thus the blood in one part becomes 
bile, in another saliva, in another urine ; and so on, by the 
exercise of its peculiar attractions or affinities in the parts in 
which it is passing ; precisely on the same principles that 
in certain states of heat, water appears in vapour, then in 
the fluid state, then in very hard ice ; and so on of every 
body in nature, assuming the different condition or quali- 
ties peculiar to them in each different state in which they 
are placed. According to this theory, we have only to 
change the state of any part diseased, in order to change 
its secretion ; this is done in many ways, but most remark- 



63 

ably by exciting contractions in the fibres, as by blood-let- 
ting, cold, fox-glove, lead, and the lik>- articles. 

It is upon this principle oi natural attractions, that when 
a part of the body is cut open, as in any wound, the parts 
living brought in contact, attract and unite together, the 
intervening blood, when in small quantities, forming a me- 
dium favouring the operation. I mention this, as it af- 
fords an opportunity for representing to you the folly of 
the many articles applying to wounds to make them heal. 
Every body has something to recommend for this purpose; 
with such poor advantage, however, that the escape of 
wounds from ulceration is a great affair. The great se- 
cret, ladies, in curing wounds, is to put nothing on them ; 
not even sugar, salt, brandy, British oil, nor any of the 
other articles so generally daubed on. When a wound is 
made, nature supplies the balsam ; it is the blood of the 
part. Bring the sides as closely in contact as possible, 
immediately, and keep them so by sticking plaster ; keep 
the air excluded by a greased or waxed rag over the edges, 
and the parts at perfect rest. Nothing is so important as 
to keep wounded parts perfectly quiet, that the attractions 
and union may be undisturbed ; nothing so important as 
to keep away all the old women's prescriptions for healing. 

The next subject to which I shall request your atten- 
tion, with the hope of your receiving some practical be- 
nefit, is the formation of fat in our bodies. In certain 
states of the system, the blood, passing through the parts 
formed for the transformation, is converted into fat, and 
deposited in places made for its reception. In another 
state of the system, this said fat is turned into blood. 
You have no doubt heard that bears go into their dens for 
the winter very fat, live months without food, and turn out 
in the spring very healthy, though miserably reduced in 



6* 

bulk. Daring the winter their abundant fat has been con- 
verted into blood, the article necessary for the various 
parts of their bodies. Just so with ourselves in fevers. 
We have fevers, we take no nourishment, we are daily- 
evacuated, we may daily lose blood, in the last stage we 
shall have more blood than in the beginning of the attack ! 
Our systems have been busy in the transformation of fat 
in the innumerable cells of our body into blood. Having 
then an abundance of blood, you should never more in- 
dulge in fears from repeated bleedings, when directed 
by physicians ; you should never again so incessantly 
counteract the directions of physicians, by tempting and 
almost stuffing the patients with articles adding to the dis- 
ease ! Abstinence, when prescribed by the doctors you 
confide in, who judge from the state of the patient, should 
never be counteracted by the mistaken kindness of females. 
You must believe this, if you view the power of nature in 
transforming the deposits of the body into the commodity, 
blood, which is wanted for her purposes. She procures 
it in her mode without any extraordinary exertion of pow- 
er or action that we perceive, while, on the other hand, 
when we attempt the supply by nutritious, stimulating 
food, the irritation produced does more harm than good. 

Although I represent this subject for the purpose of 
preventing an improper interference in cases where low 
diet is prescribed, and to prevent an unnecessary uneasi- 
ness in those whose sympathies are excited for the sick, 
from impressions of defect of food ; I would not prevent 
your kindness in supplies of the food proper for the patient. 
Indeed, without the offices females generally perform, I 
should look upon recovery from a long attack as a kind of 
miracle. Our bodies have a strong propensity to return to 
their old habits ; and often the excitement of an action that 



65 

has been suspended, will restore the habit of action to eve- 
ry part of the system. The eating of an article, which, by 
its bulk, restores the stomach to its accustomed state and 
action, has often, especially when given at the accustomed 
hour, been very instrumental in restoring health. It is 
right then to show your kindness, but not in giving articles, 
and at improper times, in opposition to medical prescrip- 
tion. I could not state to you any thing more, showing 
the importance of keeping up these habitual actions, than 
the experience on the subject of fasting. A man who eats 
nothing for a few days, will become feverish, and expire in 
a very little time. But if he will pregerve the habitual ac- 
tion, or operation of his stomach, although there shall be 
nothing added to his body, yet he will live in tolerable 
health for a considerable time. If he will observe the pre- 
caution of opening one of his veins, and daily suck in half 
a pint of blood, his stomach will be kept in action, and his 
system will supply the deficiency, by forming blood from 
his inactive fat, for all the purposes of his body, so that he 
may certainly live, and in tolerable health, forty days and 
forty nights, without encountering any serious disadvan- 
tage. This fact ought to be impressed on every person 
who may possibly, for short periods, be exposed to total 
deprivations of food, from shipwrecks, besieges, or any 
other sources of starvation. If they would have this blood 
drawn and boiled with water, they would fare with better 
comfort. 

The last subject on which I shall make general observa- 
tions, is the various connections between different parts, 
called sympathy. This is one of the most important parts 
of the study of those desiring to treat the sick with pro- 
priety ; and affords an additional reason why there should 
not be a meddling with physic among those not qualified, 



66 - 

In consequence of this sympathy, when one part is dis- 
eased, another part will take on the diseased action. Thus, 
when the womb is inflamed, there shall be great sickness 
at stomach in one person, in another affection of the 
breasts ; the remedy of course to be directed to the part 
primarily affected. Thus, when the stomach is affected, 
there shall be excessive pain in the head. When the liver 
is affected any length of time, the skin, particularly of the 
face, takes on diseased action. When the stomach is af- 
fected, by putrid meat, for example, the skin will become 
spotted. When a wound is made in one of the extremi- 
ties, often the parts near the junction of the limb with the 
body will become affected * 

It is often by means of this sympathy that we cure parts 
affected. We excite the kidnies, for example, to an in- 
creased secretion of urine, by water and salts in the stomach. 
We cause the dispersion of large collections of matter, by 
the administration of an emetic, and so on. 

This short view I have given of a few general princi- 
ples, I hope will be sufficient to make such a forcible im- 
pression on your minds, as will forever root out all further 
belief in great cures, by quackish prescriptions, as before 
observed. Each case of disease occurring, requires the 
exercise of a sound sense for its treatment. The adminis- 
tering of an article to cure one patient, because it cured 
some others, must of course be improper, unless there be 
reason for belie ving that the state of the different persons 
is the same. Admitting what I have advanced to be true, 
can you put further faith in stories of great cures by treat- 
ment contrary to principles, to common sense, although 
many should tell you, although you might fancy you saw 
the effect yourself? Such instances of recoveries only 
show the power of nature in restoration ; the supposed re«? 



67 

medy was not the instrument. Could you believe that any 
stimulating article, as brandy or opium, or the like, could 
cure an inflammatory fever ? or that heat, restlessness, 
food, or stimulating drinks, could fail making it worse ? 
Could you believe that in diseases of low action, called 
nervous or typhus, that great evacuations would fail to de- 
stroy ? Would you believe that moving a child during 
high fever, would not make it worse, although an hundred 
told you to the contrary ? Indeed, you may believe me, 
although sometimes it may appear very hard to dose one 
to death, there is not one disease which is not to be treated 
according to principles, and not one to be treated according 
to " guessing." 



m 



LETTER IV. 



Contents. Menses — history — treatment — excessive- — ob- 
structed and suppressed — period of cessation—fluor albm 
er -whites — hysterics- — indigestion — healthy food. 

I commence this letter with the remark, that you gene- 
rally err in attaching so much importance to the periodical 
discharge, called courses or menses j and in thinking so 
much of it on the approach of diseases. The apprehen- 
sions on this subject, amounting to excessive anguish, 
which annoy so many women, are entirely groundless. It 
is not material whether it be great or inconsiderable, regu- 
lar or irregular, early or late in its appearance. 

The following history of this evacuation is from Dr. 
Denman. " At whatever time of life this discharge comes 
on, a woman is said to be at puberty, though of this it is a 
consequence, not a cause. The early or late appearance of 
the menses may depend upon the climate, the constitution 
the delicacy or hardships of living, and upon the manners, 
as hinted by Rousseau, of those with whom young women 
associate. Heat appears to operate on women as on fruit, 
producing earlier ripeness ; as the warmer the climate, the 
sooner the menses appear. In Greece, and other hot coun- 
tries, girls begin to menstruate at eight, nine, and ten years 
of age ; but advancing north, there is a gradual protraction 
of the time, till we come to Lapland, where menstruation 
does not occur till a maturer age, then in small quantities, 
at long intervals, and sometimes only in the summer. 



70 

" In hot climates, women are in the prime of their beauty 
when they are children in understanding ; and when their 
understandings grow to maturity, they cease to be objects 
of love. In temperate climates, their persons and minds 
arrive at maturity at the same time ; and by the united 
power of their beauty and intellect, they become irresistible. 
" Some girls begin to menstruate without any preceding 
indisposition ; but generally there are appearances or symp- 
toms, indicating that it is about to take place. These are 
usuallv more severe at the first, than in the succeeding pe- 
riods ; pains in the back and inferior extremities, affections 
of the abdomen, with hysteric and nervous affections. 
These commence with the first disposition to menstruate, 
and continue till the discharge comes on, when they abate 
or disappear. 

" The quantity of bloody secretion discharged at each 
evacuation depends on climate, constitution, and manner 
of living ; but it varies in different women in the same 
state, and in the same women at different times. In hot 
countries it is near twenty ounces, in the coldest about two 
ounces. There is also a difference in the time required 
for the completion of the discharge. In some it returns 
precisely at stated periods, in others there is a variation of 
several days. In some it continues but for a few hours, 
in others for ten days ; but from three to six days is the 
most usual period. 

" At the approach of old age menstruation ceases, the 
time depending on the time of its appearance ; that is, ear- 
ly or late, as it occurred in each case. When it took place 
at the age of ten or twelve, it ends about the fortieth year; 
when about the twentieth, it continues till about the fifti- 
eth, sometimes till the sixtieth year ; but in middle tempe- 
rate countries, the period of its cessation is the forty-fifth 



71 

-/eat. By this constitution of women the propagation of 
our species is happily confined to the most vigorous part 
of life. 

" The discharge is a secretion coming from the vessels of 
the womb, and ceases when impregnation takes place. 
Sometimes it is confounded with periodical evacuations 
from these parts of blood, often from the vagina, and er- 
roneously has been supposed to occur occasionally during 
pregnancy. Of the cause of the discharge it can only be 
said, it appears to be a provision of nature to accustom the 
womb to great discharges, preparing it for the supply of 
the substance constituting the body of the child." 

During this evacuation, women ought to be as quiet as 
practicable. They should be, particularly at this time, ex- 
tremely cleanly. The statement by Moses of what he sup- 
posed the Lord said, " women should not touch any thing 
after this issue for six or seven days,"was designed to ensure 
greater attention to cleanliness. Morning and night they 
should sit in a tub of warm water a few minutes, for effec- 
tual washing. The common prejudice against the use of 
warm water in this state should be disregarded, as it is 
not only of no injury to the general health, but is of real 
service in lessening the irritability of the part. The diet 
ought to be rather less than common in quantity and qua- 
lity. Sudden exposure to cold, rain and alarms, should be 
avoided, though frequently encountered without injury. 

The womb from whence the menses come is subject to 
great varieties of diseased action ; and it is a subject of re- 
mark and astonishment, how much the stomach, head and 
pulse sympathise on such occasions. There are almost 
always symptoms of hysterics, despondence, sickness 
at stomach, and low pulse. The chief varieties of its dis- 
eased action are classed under the heads of excessive, ob~ 



-*1 

structed, and suppressed menstruation. Most women oc- 
casionally are affected with different degrees of these varie- 
ties. Considering their habits of living, so contrary to 
the activity for which they were formed, it is astonishing 
they do not more severely suffer. 

The remedy for these affections is .generally sought for 
in physic, but most erroneously. There are no diseases 
you are subject to, not more under the controul of medi- 
cine, yet none more easily prevented and relieved by the 
exercise of common sense, in attention to habits. 

Like all animals breathing much air and eating freely, 
women were made for exertion, their fluids for constant 
circulation. Each part must expend by exertion so much 
of its irritability; or disease will appear. Among the In- 
dians and labouring class of women, there are but few if 
any cases of this disease. This alone should be sufficient 
to induce all subject to these complaints to seek relief in 
imitating the diet, exercise, and habits, of those who live 
agreeably to nature. 

EXCESSIVE MENSTRUATION. 

The first variety mentioned of the diseases of menstrua- 
tion, was excessive discharge. This is usually greatest in 
most robust women, of indolent habits. In some it is pro- 
fuse at once, in others it continues for several days reduc- 
ing the system greatly, to extreme weakness. In this dis- 
ease there is too great determination of blood to the 
womb, too much action in its vessels. The remedy is the 
dictate of common sense, equalise the action. This is to 
be done in persons very full of blood, to be determined by 
the pulse, or the feverish state of the system, by blood 
letting, by purging with salts, oil, or magnesia ; and by 



exciting action in other parts of the body. During the 
discharge, the patient should keep cool in bed, the hips a 
little elevated ; abundance of cool fresh air to be admitted 
in her apartment. A vomit of ten or twelve grains of 
ipecacuanha, or a grain of tartar emetic, may be given eve- 
ry half hour, until the stomach is fully excited. When 
the discharge of blood is profuse, there should not be the 
least hesitation in introducing up the the birth place, cold 
water ; by injecting it with a syringe or any common 
squirt, or by pushing up wet cloths. Sitting in a tub of cold 
water will often answer ; an injection of sugar of lead water 
(a tea spoonful of lead to a pint of water) is a more certain 
remedy, but it should not be tried till the other prescrip- 
tions fail. In moderate cases wet cloths from cold water, 
or ice in a bag, applied to the abdomen, will afford relief. 
When the blood flows in an alarming quantity, it is by all 
means necessary to prevent its passage, by stuffing cloths 
up the birth place. Bleeding from the arm, the patient sit- 
ting up to favour fainting, should always be done, if the pa- 
tient be not already too much reduced. Two grains of 
sugar of lead, with a quarter of a grain, or not, of opium, 
may be administered every two hours, until the discharge 
of blood is reduced. After this a purge should be given to 
carry off any remains of the medicine in the bowels. In com- 
mon cases simply purging, keeping cool on a sofa, avoiding 
all stimulating diet or drinks, is all that is requisite during 
the discharge. 

But the great object is to prevent returns of this exces- 
sive discharge. The only effectual means for prevention 
will be found in attention to the general health, as pointed 
out on the subject of the skin. In addition I would urge 
every woman subject to it, to revolutionize her habits, to 
spend her time between the discharges very different from. 



formerly, taking different exercise, diet and drink ; parti- 
cularly exciting a powerful action on her skin by frictions, 
by coafse applications, by cold and salt bath, and by blis- 
ters. About the time for the return, she should lose blood, 
particularly if of a full habit of body. She should devote 
unusual attention to her daily evacuations from the bowels, 
sitting daily in cold water, and to relieving her mouth 
from the irritation of rotten teeth. It has been suggested 
by a respectable physician, to cup the breasts, with a view 
to excite such a determination to them as would divert 
from the womb. 

But I have no hesitation in recommending, as of far su- 
perior importance, the excitement of the breasts to the se- 
cretion of milk. The means of doing this will be particu- 
larly explained when on the subject of barrenness, to which 
I refer. The discharge being excited, I would advise it 
to be continued daily for two or three months, and in all 
probability it will relieve the determination to the womb, 
causing its excessive bleedings at least the more certainly, 
if aided by attention to the first advice. 

OBSTRUCTED MENSTRUATION. 

Unmarried women are most subject to this disease. 
The variations of it are from total to partial suppression ; 
attended with little or great pain, and often marked by af- 
fections in the other parts of the system, from sympathy, 
analagous to those characterizing the pregnant state. 

"When menstruation first takes place, it is usually at- 
tended with pain, head-ache, and feverish symptoms. 
These generally go off without requiring any particular 
treatment. But when they are considerable, or the per- 
son delicate, it is best to favour the evacuation, by sitting 



75 

in a tub of warm water ; this may be continued for hours 
when the pain or irritation is great. Dipping the feet in 
as hot wate r as can be endured, or in strong lye, or lime 
water, as is done for curing whitlow, or inflammation of the 
finger, will prove of service. It is not designed for the 
purpose of exciting perspiration, but to produce a scorch- 
ing, or sense of burning, which will increase the determi- 
nation to the lower parts. When the pains of the patient 
are considerable, blood should be taken from the arm, and 
sweet oil be applied all around the belly and small of the 
back. 

More serious attention is necessary in cases where the 
discharge is suppressed after it has taken place. Strong 
passions of the mind, and exposure to cold during the 
menstrual period, frequently check the evacuation, which 
is followed by fever, by inflammation of the womb, and 
its attendant symptoms, pains in the neighbourhood, sick 
stomach, head-ache, and general appearances of fever. In 
every such case, it is proper that the patient should imme- 
diately sit in a tub of hot water, go to bed, take a purga- 
tive, and lose a little blood. 

When the evacuation is obstructed for a length of time, 
more serious disorders ensue ; " indigestion, sickness, va- 
riable appetite, heart-burn, distension of bowels, head- 
ache, palpitations, and many hysterical symptoms. Some- 
times the face becomes pale, the eyes sunk, the bowels cos- 
tive, pulse contracted and irregular, tongue foul, feet 
swelled, belly tumid, appetite diminished, craving of 
chalk, or indigestible food, the sleep interrupted. 7 ' 

In order to bring on a return of the menses, it is of the 
greatest importance to attend to the time when they should 
take place, as then the -greatest efforts are to be made. 
The patient should have a small blister applied about a 



76 

day or two before trie time, between the fundament and 
birth-place, called perineum. A purgative should at the 
same time be given, of four or five grains of aloes ; to be 
repeated twice or three times. The next advice to be ob- 
served is, to sit in a tub of as hot water as can be endur- 
ed, suddenly getting in and out of it. In a greater degree 
the feet should be scalded. Sometimes blisters applied to 
the ankles for three or four hours to redden the skin, have 
afforded relief ; as also to the lower part of the belly, or 
to the small of the back. 

If these remedies do not succeed, it is proper, in addi- 
tion to their use, to inject in the vagina a mixture of strong 
brandy and water, as hot as can be borne, or of any thing 
else that will slightly irritate and inflame the parts, such 
as vinegar, wine, strong brine, and the like. The more 
the patient at the expected time moves about, by walking, 
riding, or jumping, the better. Electricity, used by draw- 
ing sparks from the thighs and neighbourhood, has been 
stated to be serviceable in many cases. Ligatures or ban- 
dages tied around the thighs, so as to compress the veins 
and not the arteries, a day or two previous, is also a reme- 
dy well worthy of trial ; they are only to be continued an 
hour or two at a time, till the blood collecting in the legs, 
they are to be removed. The momentary distension pro- 
duced, tends to excite a new and increased action in the 
lower parts, and thereby relieves the disease of the womb. 

It is often of service to lose a little blood, if the general 
health bs good ; also when there is reason to believe the 
least fever exists. The change produced in the constitu- 
tion by this evacuation, tends to favour the return of the 
womb to its natural action. 

In guarding against this complaint, the health of the 
constitution is to be kept in view. I refer you to what 



77 

was recommended for the health of the skin. And I will 
only add, that you should be more cautious in avoiding ir- 
regularities, in taking exercise in open air, on foot, or on 
horseback, in having your skin well rubbed with a coarse 
brush every night, in evacuating your bowels every day, 
in having your decayed teeth extracted, lastly, in using the 
salt bath every morning, until within a few days of the ex- 
pected return. 

PERIOD OF CESSATION OF MENSES. 

This is with most women a very critical time, and de» 
serving of more attention than is generally paid to it. 
During all changes in the constitution, diseases are most 
apt to creep in ; and never more so than at the revolution 
taking place in the womb at this period of life. As stat- 
ed in the history of this evacuation, it disappears from the 
forty-fourth to the fiftieth year, preceded by varying irre- 
gularities in its appearance and symptoms. 

Medicine can afford no relief ; yet there is no affection 
so perfectly under the controul of management. It is the 
dictates of common sense, not the effect of doses, that are 
to be regarded. You know that this discharge for thirty 
years has been attended with considerable action and irri- 
tation in the womb, and great determination of blood to 
the part affording the secretion. The important object, 
then, on the cessation, must be to accustom the system 
gradually to the loss of irritation, and discontinuance of 
secretion. This is to be done by exciting temporary ir- 
ritations in other parts, and by exhausting in exercise the 
superfluous quantity of blood, and by abstinence. 

The means for the prevention and the cure of the affec- 
tions arising at this period are the same. There should be 

7 



an unusual action kept up on the skin, by the roughest rub* 
bing of it daily. During half of every day, very coarse 
flannel, or coarse oznaburgs, should be worn next the 
skin ; by wearing it longer, the skin becomes so fa- 
miliarized to it, that no effect is produced. A pair of 
drawers, and waistcoat for the body, is the best mode 
of applying this irritating- dress. Of the utmost impor- 
tance is exercise in open air, riding, walking, and throw- 
ing the arms around the body, as is sometimes done to 
warm the hands, or cutting a little wood, or any exercise 
like it. The diet at this time should be lessened for seve- 
ral months. Purges of salts or oils, not aloes or jalap, or 
anj 7 gum, should be taken to evacuate the system ; and it 
is proper occasionally to lose a little blood, especially 
among the robust. It is of the utmost importance to keep 
the birth-place perfectly clean, as the retained secretions- ir- 
ritate and excite diseased action in the womb. Above all, 
keep the bowels daily open, and whenever irritation or pain 
is felt, try the general warm bath, or at least sit in a tub of 
warm water, and until the pain goes oft remain quiet. 
When there appears to be considerable disease in the 
womb, to be judged by pains in it, and around the back, 
and by the sympathy of other parts with it, as pains in the 
stomach, head and breast, it is proper to apply a blister 
plaster between the shoulders. In milder cases, the ap- 
plication of this plaster two or three hours, to redden the 
skin without blistering it, will do much good. The injec- 
tion of warm water up the birth-place, will also be of con- 
siderable service, as also injecting it up the bowels. If the 
inflammation of the womb be considerable, it will be proper 
to vary the injection, to substitute cold water and a solution 
of lead (a tea spoonful to the pint) for the vagina. A large 
blister over the belly, to be dressed with mild sweet oil, will 



79 

greatly assist in diverting the action from the internal 
parts. 

I wish to impress you strongly, that you are not to seek 
relief from opiates, so generally and improperly taken. 
They add to the disorder, by stimulating the system, al- 
ready too inflammatory — sometimes most inflammatory 
when -the pulse is low. The warm bath continued, blood- 
letting, keeping the body quiet and cool, afford the only 
safe anodynes in these cases. 

By attending to these general directions, I can safely 
promise you, as the result, relief from present pain, and 
from a distressing succession of future complaints. No 
lady need apprehend cancerous womb or breasts, who will 
give a reasonable compliance to what I have urged ; nor 
indeed will they have any of the affections occurring at this 
revolution in the system. 

FLUOR ALBUS OR WHITES. 

This is an increased secretion from the glands lining the 
vagina and womb, and it is an affection so local, that the 
constitution is seldom affected by it. The qualities of the 
discharge vary considerably. " In the mildest form it is 
slimy, resembling the white of an tg§, having very little 
colour or smell. In the next degree, it is of a yellowish 
colour, but the colour not very deep, and the discharge not 
offensive. In a greater degree of disease, the colour is in- 
clined to green, and the discharge is slightly offensive, and 
somewhat irritating. In the worst form, it resembles 
purulent matter, is ill smelled, and frequently mixed with 
blood. 

" The simplest and slightest kind is not attended with 
pain in the back - 3 the general health not much affected j 



80 

the strength scarcely diminished, though the back is rather 
weaker. The menstrual discharge is not interrupted, or 
irregular. In the next degree, the back is constantly weak, 
and after any exertion aches considerably ; the power of 
digestion is diminished, and the bowels are generally cos- 
tive, the menses continuing pretty regular. Sometimes 
there is a feeling of heat and itching about the lips of the 
vagina. In a greater degree of this complaint, the back 
is constantly painful, and very weak, and there is a feeling 
of much weight or relaxation about the lower part of the 
belly and top of the thighs. The menstrual discharge is 
either_ obstructed, or rendered irregular or profuse. The 
stomach is much impaired in its vigour, the bowels costive 
and flatulent ; there is want of appetite, heart-burn, the 
face pale and unhealthy, palpitation, hysterical appearances; 
and the constitution seems altogether to be very much de- 
bilitated. This state is always productive of barrenness, 

" The quantity of this discharge is as variable as the 
quality ; in some cases very little, in others very profuse ; 
in some continuing uniform, in others it increases or di- 
minishes, or may altogether disappear for a day or two, or 
for a longer period. While the menses continue, the dis- 
charge of this disease often increases before and after the 
monthly period : sometimes when the menses are obstruct- 
ed, it is greatly increased, attended with additional pain in 
the back : when the discharge comes from the womb alone, 
and not from the birth-place, it is sometimes interrupt- 
ed for a day previous to menstruation ; and if the patient 
conceive, it immediately stops. On the other hand, the 
discharge from the passage alone is often increased during 
pregnancy ; and in some instances, takes place only at that 
time. 

" This disease may arise from many causes, but par- 



81 

ticularly from those impairing the power of the womb it- 
self ; as a severe labour, or miscarriage — particularly if the 
patient get up too soon, and mismanage herself, or Irom pro- 
fuse menstruation, or much fatigue, or exposure to cold at 
the menstrual time, or at any time, in the same way as dis- 
charges are produced from the glands of the nose, or wind 
pipe, which we observe in colds."— Dr. Burns. 

The treatment of this complaint depends on its degree ; 
in slight degrees of it, washing two or three times a day 
in cold water is sufficient. It is best to inject the water 
into the passage to the womb. In all cases, great cleanli- 
ness should be observed, as the excretion remaining in the 
passage changes to an acrid, irritating state, and increases 
the secretion. 

If the use of cold water do not suffice, it will be proper 
to use other articles that abate inflammation. The best 
is sugar of lead, about a tea spoonful to the pint of water, 
injected at least three times a day. The same quantity of 
white vitriol, in equal solution, is also esteemed of great ef- 
ficacy. Lastly, four or five times the quantity of alum in 
the same quantity of water may be used. If the discharge 
be very offensive, a small spoonful of very finely powdered 
charcoal, may be introduced up the birth-place every 
night and morning, until it is corrected. Sometimes a 
small quantity of laudanum may be added to the solutions 
injected. Such treatment never fails to give present relief. 

But it is of the greatest consequence to prevent returns 
of the discharge, by diverting the action of the blood ves- 
sels to some other part of the body. All the means point- 
ed out for relieving profuse menstruation, must be pur- 
sued ; they are to be applied in the one case as rigorously 
as in the other. The only additional direction I have to 
give, is, to apply a small blister, either between the birth- 



place and fundament, (called perineum,) or a large one on 
the small of the back, or in front of the lower part of the 
belly j at the same time, more freely using the injections, 
to restrain the action of the vessels in the birth-place. I 
conclude, urging you to preserve the general health by the 
means pointed out before, especially by exciting action on 
the surface of your body ; and take great care never to let 
any old acrid matter remain on the part, or in the bowels. 

HYSTERIC TITS. 

The following description of this disease by Dr. Den- 
man, is as good as can be given. " In a well marked hys- 
terical fit, a sense of pain or fulness is felt in the belly near 
the navel, or towards the left side. This gradually spreads, 
and a sensation is felt as if a ball passed upwards and 
stuck in the throat. The patient now usually falls down 
insensible, or convulsed, and seems to suffer much in 
breathing, sobbing violently, or uttering a kind of shriek. 
She is generally pale, and frequently apparently insensible 
during a great part of the fit ; or seems to be in a faint : 
but when she recovers, she is not only conscious of having 
been ill, but also of many circumstances which occurred 
during the fit. After remaining for a considerable time 
in a state of muscular agitation, alternating with an appear- 
ance of fainting, the affection abates. She utters deep 
sighs, opens her eyes, and looks around her, as if surpris- 
ed, and at length recovers both composure and sensibility, 
but remains for some time languid, and complains of head 
ache. This restoration is accompanied with eructation, and 
the discharge of a quantity of limpid urine. The dura- 
tion of the fit, as well as the circumstances attending it, va- 
ry much. In some instances it lasts only a few minutes, 



83 

in others, for more than an hour. Sometimes there is 
great muscular agitation, or pretty strong convulsions ; at 
other times, the fit resembles more a faint. In some in- 
stances, violent fits of laughing and crying alternate with 
each other, whilst in many cases these symptoms are en- 
tirely absent." 

Most women are subject to some of the irregularities 
of this disease, as manifested by too acute sensibility. 
The time is about the period of menstruation, when their 
systems appear to have great irritability. The acrid se- 
cretion coming from the womb, tends to irritate the exter- 
nal parts and produce the disease : and it is also probable 
that it is always attended with some particular state of the 
womb itself. 

They are most subject to it who lead a sedentary life, 
breathe foul air, and retain their excrement too long in the 
bowels. The acrid contents of the lower guts readily ex- 
cite action in the adjoining womb, and produce disease. 
Next the adherence of the ordinary secretion of the glands 
about the birth-place, which, irritating the sensible parts, 
cannot fail to produce similar effects. Lastly, irregulari- 
ties in eating and drinking. The disease once excited is 
very apt to become periodical, and appear without any ex- 
citing cause. 

The prevention consists in guarding against the causes 
mentioned with the most earnest diligence. To sleep 
with the bed room door open, and to take moderate exer- 
cise out of doors daily, is indispensably necessarv ; or by all 
means, they should sit daily in a tub of cola water. The 
excitement of any sudden or strong passions should be 
carefully avoided, as also indulging any length of time in 
particular habits or whims. Travelling and salt bathing 
are of great service. Wlien it is necessary to open the 



8* 

bowels with medicine, it should be done with aloes, in pre- 
ference to all other purges. Glysters are extremely ad- 
vantageous. About the time the fit is expected, it is best 
always to take about five or six grains of aloes, as well as 
a glyster. Purging is extremely proper, as the contents 
of the bowels are always offensive in this disease. A des- 
sert spoonful of prepared chalk, or as much charcoal in 
yeast, will tend to correct this offensiveness. The system 
of the person should be as much revolutionized, or chang- 
ed, in order to destroy the habit of such returns of action, 
as possible. Bleeding in addition to the purging is pro- 
per. An emetic may be given with greatest advantage, 
before the expected time. The skin should be irritated 
by the roughest friction ; the mind should be kept as 
mildly occupied as possible. This disease is most assur- 
edly under the controul of such treatment, earnestly at- 
tended to, and its recurrence among those aware of the pre- 
vention, affords some grounds for reflection on their lazi- 
ness and inattention. 

The treatment when the fit comes on is very simple. 
Let the patient be placed in cool air, on the bed or floor, 
and turn and writhe, so long as they do not hurt them- 
selves. This is to be prevented by holding them. Vola- 
tile salts, or any thing pungent, or offensive to smell* 
should be held to the nose. It is said, a Yankee Doctor, 
not having any thing at hand, once successfully applied 
his toes to the nose of his hysteric patient. The limbs 
should be rubbed with a stiff brush. The moment it can 
be done, pour down the throat, either twenty grains of ipe- 
cacuanha, or a solution of three grains of tartar emetic, or 
a table spoonful of antimonial wine. As soon as the vomit- 
ing commences, the fit generally ceases. After the opera- 
tion of the vomit, you should give of aloes and asafoetida, 



83 

of each four grains, to be repeated on any symptoms of 
the return of the disorder. If none be at hand, give thir- 
ty or forty drops of laudanum and any purgative* If lauda- 
num be not at hand, use a glass of brandy ; but beware of 
its leading to dram drinking, as has often been the unhap- 
py case. 

It has been supposed that this disease arises from a pe° 
culiar state of the womb. Our means of operating on the 
womb are but few j we have none more powerful than 
through the breasts. I would therefore press on those 
subject to periodical returns of hysteriad, which do not 
yield to the treatment before suggested, to excite the 
breasts to their healthy action, the secretion of milk so as 
to influence the womb. The means of doing this will b? 
stated on the subject of barrenness, to which I refer. 

INDIGESTION. 

The last complaint of which I shall make a few obser- 
vations, is one of which every one has occasional attacks 
in lesser degrees. The difficulties of digestion are com- 
plained of as universally as the subject of digestible food 
is discussed. 

Indigestion of greatest degrees, is sometimes marked 
by " sickness of stomach, vomiting, and excessive flatu- 
lence : also, heart-burn, hiccup, water brash, acidity, head- 
ache, lassitude, unhealthy complexion, bad sleep, high co^ 
loured urine, &c. Some modifications of this disease are 
attended with vomiting of blood or of bile ; severe pain in 
the stomach, or are connected with uneasiness in the right 
aide j bloody coloured urine, pain in the top of the shoul- 
der, yellow complexion, repeated fits of vomiting, &c« : 5 ' is 
short, by all the symptoms of diseased liver, of which it is 

M 



86 

sometimes a symptom. When the liver is affected, the 
best medical men should be consulted, and should super- 
intend the salivation of the patient, which affords the only 
chance of cure. 

Lesser degrees of indigestion arise from sedentary life, 
occur to those of costive habits, too lazy to take the trou- 
ble to evacuate the bowels every day. Persons who eat 
irregularly large quantities of articles they are unaccustom- 
ed to, drink immoderate stimulants, or eat them as in 
spices, are subject to serious degrees of this disease ; as also 
those who have rotten teeth. 

The cure will, in most cases, be perfected by avoiding 
the causes. When it is not, it will be best to consult a 
physician. Costiveness and a sedentary life are easily to 
be avoided. The general health is particularly to be pro- 
moted by rubbing the skin with the brush, and wearing 
coarse flannels irl contact, and by the salt bath. Lastly ,. 
but not of least consequence, is the diet. 

To determine what is the best article of diet, what the 
most healthy food, although talked of by every body, is 
a most difficult task. Indeed, the most extensive obser- 
vation leads to the conclusion, that there is no diet, healthy 
or unhealthy, but that all depends on our habit of using 
the particular kind. It is habit that familiarizes the sto- 
mach to the digestion of each article ; and it is inattention 
to this habit, indulging in sudden changes from one to 
another diet, that has induced so many persons to pro- 
nounce so many articles unhealthy. 

As soon as there is the least reason for believing the 
stomach to be disordered in its digestion, it becomes the 
patient to observe the greatest regularity in eating, as to 
time and kind. The most simple food, and that of which 
most has been eaten during life, should be selected. When 



>-SX>< 



87 



it is necelbary to change, be sure to change most gradually, 
taking at first but a mouthful daily for several days pre- 
vious to changing altogether. The propriety of this 
is confirmed by the sickness so generally produced in 
spring seasons, when the food is changed. Nothing more 
shows this than the nausea so generally felt after eating 
fish the first time ; and similar are the effects produced by 
eating large quantities of any new fruit. Although we 
may not be sensible of it, in our common changes, ne- 
vertheless, very considerable effects are produced in the 
stomach by all variations in diet. Instead, therefore, of 
deceiving you, as some physicians often do, by advising 
you to confine yourselves to veal, fish, pork, or fowl, that 
they may gain reputation by the fancied skill displayed in 
the selections, I state the truth, that the good effects arise 
from the confinement ; and that, in all human probability, 
one kind of meat, one article, is precisely as good as ano- 
ther. To this I will add, that rest after eating greatly 
facilitates digestion. This is unquestionably proved by 
an experiment often repeated. To two similar healthy 
animals equal quantities of food have been given ; the 
one kept moving, the other perfectly quiet, for a few hours. 
On killing and opening their stomachs, the food in the one 
at rest is always found digested, the other not at all. To 
eat but few articles regularly, to change the kind very gra- 
dually, to keep quiet for three or four hours after eating, 
is the sum of all that can properly be said on the subject 
of healthy or unhealthy diet. 

When the eructations from the stomach are very acid, 
chalk and magnesia, or a quarter of a tea spoonful of pot- 
ash, or of soda mixed in milk or water, may be taken two 
or three times a day. When the stomach has been destroy- 
ed by the operation of strong stimulants, as spices, drams, 



68 

opium, or strong tea, it is necessary to substitute, in lesser 
degrees, other stimulants to promote digestion, different 
from those which have been freely used. The quantities 
or proportion must be regulated by previous habits, and 
should, with those who desire to be restored to health, be 
gradually discontinued altogether* 



S9 



LETTER V- 



Contents. Description of organs of generation — their 
diseases — child's head — suppression of urine, and draw- 
ing off with catheter—falling backwards—downwards 
— turning inside out of the womb — dropsy of the fe~ 
male testicle — venereal disease* 

I have now to give you a description of the parts con- 
cerned in generation. It is not my design to attempt mak- 
ing more than such a general statement as will enable you 
to think and speak with tolerable accuracy of the parts. I 
have witnessed so many groundless fears, so many dread- 
ful forebodings on the slightest appearance of disease in 
this region, that I feel confident you will be greatly benefit- 
ed by a more correct knowledge of them. To make you 
certain that they are like all other parts of the body ; have 
nothing of a wonderful nature about them, and require 
for the treatment of their diseases simply the exertion of 
sound sense, will be of advantage. 

In describing them, it is customary to do it under the 
divisions of hard parts, meaning the bones, and soft parts, 
including the external and internal. 

The bones immediately concerned in generation are 
those forming the circle around our bodies, about the hips, 
collectively called the pelvis, a name you may readilv re- 
member. This pelvis is formed by the union of separate 
bones, of which you should remember particularly the end 
of the back-bone, called sacrum. This bone turning 



90 

round as it were our rumps, forms a considerable curve 
and hollow, as you will perceive by reference to figure the 
second, representing it split down and a, side view. The 
end of this sacred bone, or sacrum, is called os coccygis ; 
which is so joined as to move a little backwards and out- 
wards at births ; particularly among those who marry late 
it sometimes makes a noise in moving. The sacrum is 
connected to the hip bone on each side (called os ilium,) 
and these hip bones unite to a bone on each side towards 
our front, called os pubis. Each os pubis unites in the 
centre to each other, and forms what is called the sym- 
phisis, or union of the pubes. This union has at- 
tracted more attention than any other of the pelvis, be- 
cause it is sometimes defective after child-bearing ; and 
sometimes it has been divided to facilitate the passage of 
the child's head ; a practice which experience has proved 
to be improper. In women of small pelvis, where these 
parts have been strained at birth, there is great weakness ; 
in some cases impossibility of .walking. There is no re- 
medy for this misfortune but rest, and a tight bandage 
around the hips, so as to compress them together. 

All the hard names you have to remember on the sub- 
ject of these bones are, the pelvis, meaning the bones 
around our hips collectively ; then the sacrum, or end of the 
back-bone, with its end called os coccygis ; then the pubes 
in front. With the os ilium, or hip-bone ; and the os is- 
chium, or haunch-bone, connected to it, on which we rest 
while sitting, you need not trouble your memories. 

The female pelvis is larger than that of males. It has 
been compared to a basin, without bottom, one side much 
narrower than the other. In front it is much more shal- 
low than at the back, which, as before observed, is formed 
by the back-bone, called at this end os sacrum. 



91 

The pelvis is considerably wider from hip to hip, above, 
that is, at its upper edge towards our head, than below. 
This upper part is called its upper brim, and measures 
from side to side, or hip to hip, from four to near six inch- 
es, in those of the largest size ; from front to back it 
measures from about three inches to near five. But at 
the bottom of the pelvis, when the child's head passes out 
from the bones called the lower brim, these dimensions 
change, and are reversed ; so that the widest part of the 
lower brim is from front to back, instead of from side to 
side, as at the upper brim. Understanding this, and 
knowing the dimensions of a child's head, narrowest from 
ear to ear, and knowing that nature always performs her bu- 
siness in the wisest manner, you could at once tell how a 
child's head passes through this opening at natural births. 

After reading the above, you may impress all on your 
mind that is necessary to be known on the subject ; par- 
ticularly if you will refer to the first figure, showing a 
well formed pelvis. This does not give you an accurate 
idea of the back bone or sacrum, and os coccygis, which 
is properly represented in figure the second. The nar- 
rowness of the front of the pelvis, where- the pubes unite, 
may be observed in each of these figures. These are fi- 
gures of a well formed pelvis. But the pelvis is subject 
to deformities as well as irregularities in its dimensions. 
These deformities are common in manufacturing coun- 
tries, as in England and France ; but very rare in those 
countries where the people are not cramped up, as in the 
United States. The chief deformity is the projection for- 
wards of the back-bone, so as to come nearer the pubes in 
front, and obstruct the passage of the child. Parents 
ought always to avoid giving their daughters blows on the 
lower part of the back, as they might produce the injury 



93 

of causing the spine to bend forwards. The extent of the 
obstruction produced by the sacrum on a living subject is 
difficult to be ascertained ; but an idea of sufficient accu- 
racy for practical purposes may be formed, by pushing the 
fore finger up the birth-place, in front close to the pubes, 
then moving it backwards to the projecting part of the 
sacrum. The distance the finger goes before it reach- 
es the back part or sacrum, will give you the capacity of 
the pelvis. The actual distance the finger moves must be 
conjectured. 

In order to end the dry subject of bones, I will mention 
those of the child's head proper to be attended to. From 
figures the third and fourth you may form ideas of the 
skull of an infant. You should observe and remember, 
that it is longest from the front to the back part, which 
part is called the crown of the head ! so that, when the 
chin rests on the neck, as at birth, it forms a kind of cone. 
From ear to ear the head is generally not more than three 
inches ; and the head of course adapting itself to the fa- 
vourable shape of the pelvis, would pass out its ears to the 
front and back bones of the mother, at the beginning or 
upper brim, and in descending would twist one quarter 
round, and come out with the ears towards the hips of the 
mother, as from side to side of the lower brim of the 
pelvis, it is narrowest. It is necessary to observe and re- 
member the seams marked on the figure of the scull, 
which correspond to divisions of the bones called sutures. 
You should remark that the sutures run from front back- 
wards, and from the sides upwards, and that at their meet- 
ing towards the forehead an opening is formed, called the 
front fontanelle, which is of nearly square shape, distin- 
guishable by its four corners, or angles ; at the meeting 
towards the back or crown of the head, another open- 
ing exists, called the back fontanelle, of nearly three 



/ 93 

titles, or triangular shape. It is most necessary in tedious 
labours, when the head presents, to be able to distinguish 
which of these openings is at the mouth of the womb. The 
bones forming the child's head, which you ought to re- 
member, are, the bone of the forehead, called frontal bone, 
and the bone opposite, backwards, called the occiput. The 
temple bones, at each side of the ears, and the bones 
forming the remaining sides of the head, called parietal 
bones, are not necessary for you to commit to memory. It 
is the crown bone, or occiput, that presents in the best 
cases of births, and consequently the lesser, or back fon- 
tanelle, is always felt, with its triangular or three sided 
edges. 

This formation of the head of the infant, is one of the 
master works of nature. The edges of the bones are very 
soft, of a somewhat gristly nature, readily yielding to com- 
pression ; the edge of one side passing over that of the 
other, so as to favour the variation of the shape of the skull, 
to suit the opening it has to pass. It is worthy of remem- 
brance, that so singularly pliable is the infantile head, so 
strong are the expelling powers of the womb, that in cases 
©f deformity of pelvis, the head has passed through an ori- 
fice not exceeding two inches from front to back. 

After taking into view the formation of the child's head, 
and the formation of the pelvis, it must readily appear, as 
nature always operates wisely, that the one ought to pass in 
the manner best suited to the form of the other. According- 
ly, in natural cases, it is precisely so. The head enters the 
upper part of the pelvis, called the upper brim, with the 
ears to the front and back bone of the mother, then passing 
along, it twists one quarter around, so that in making its 
escape, at the lower brim, or edge of the pelvis, the ears are 
from hip to hip ; the face, of course, towards the back* 

N 



94 

No female of reasonable mind, seeing such display of pro- 
vision for the birth of the young, ought to indulge in fears 
of her delivery ; probably more destructive in their ten- 
dency than the greatest irregularities of nature. 

The parts next to be described, are the soft parts, as ex- 
hibited externally. The front view exhibits to the eye the 
fatty elevation on the pubes, called the mons veneris, with 
its crown of hair. This mass divides, one half running 
down each side, forming something like lips, and called the 
labice ; at the bottom these lips unite again, and exhibit a 
kind of sheet, called perineum, about an inch long, and 
then disappears about the fundament, or anus. 

Upon opening these labiae or lips, the first conspicuous 
part above is a small elevation, or rising, called clitoris, the 
seat of pleasure in the sexual intercourse, called copulation. 
In some it is of very small size, scarcely perceptible, in 
other cases very conspicuous. There are numerous glands 
around this, secreting a cheesy, odorous substance, which, 
unless washed off, irritates the clitoris, and excites venereal 
desires, as before stated. Directly under this clitoris, is a 
small orifice, leading to the bladder, through which the 
urine passes. The canal leading to the bladder is called 
the urethra. 

Beneath the urethra, in some virgins, is seen a thin mem- 
brane, called hymen. In the first sexual connexion, it is 
rent asunder, and appears in ragged edges each side. Some 
virgins have had this membrane so compactly formed, as 
to prevent the passage of the menses, so that they have col- 
lected in the womb, and produced a distension like that of 
pregnancy. The remedy is to make a small puncture with 
a lancet, and allow the confined matter to pass. In many, 
this membrane does not exist. Where it has been destroy- 
ed by copulation, and the desire existed to impose the sub- 



93 

ject on some man for a virgin, the opposite sides have been 
slightly scarified, and being kept in close contact by the 
forceps, or any other means of compression, they have 
united, so that the parts have quite the virgin appearance 
and difficulty in entrance. 

The hymen being destroyed, and the parts opened, there 
is the entrance to the womb, called vagina, or birth-place, 
which in virgins is narrower than in those who are not so. 

The exterior parts, particularly the labise, or lips, are 
very subject to inflammations and swellings ; to great itch- 
ing, and to ulceration or sores. The regular application 
of cold water, as before remarked, prevents such disease. 
When itching or inflammation exists, the application of iced 
or cold water, as also a solution of sugar of lead, will af- 
ford relief. Fresh sweet oil is also of service. In cases 
of ulcerations or sores, the most simple applications are 
best. Mild mercurial ointment, mild fat, and oil and bees' 
wax melted together, are proper. The parts should be 
treated just as other parts, when similarly affected. 

Having thus given you a brief sketch of the exterior 
parts of generation, sufficient, if remembered, for all prac- 
tical purposes, I proceed to the explanation of the interior 
parts. 

As before remarked, the first orifice is that of the ure- 
thra, for the exit of the urine. Around its edge it has 
a small or slight elevation, which it is proper to remember 
as a guide for an operation which will presently be mention- 
ed. This orifice of course conducts to the bladder ; and 
it is this channel which is called the urethra. It is wider 
than the largest goose quill, and from two to three inches 
in length. 

This urethra, or canal to the bladder, is subject to con- 
siderable disease ; sometimes to obstruction, preventing 



ye 

the discharge of the urine. There is no complaint to which 
females are subject more manageable amo.ig themselves, 
and consequently which they ought to attend to with more 
earnestness ; yet the knowledge necessary is of such easy 
acquisition, the performances so simple, that an earnest at- 
tention is not necessary. Nevertheless, this little know- 
ledge, this little ability to perform, has been so neglected, 
that not only innumerable females have had to exhibit 
themselves to doctors, but many of them have actually 
expired, from want of some one to draw off their urine, by 
means of a little tube called " a catheter," corresponding 
nearly in shape to a goose quill, which has often proved a 
convenient substitute. In my undisguised opinion, it is a 
disgrace to the sex, that a man should have been called 
upon to perform an operation so indelicate, and so simple 
in its nature— rthat while a child in its senses, of six years 
of age, blushed in submitting to the operation, it would 
declare its ability to perform it on another. 

And what is the operation of introducing the catheter, 
to evacuate the urine ? The bladder containing the urine, 
is immediately under the bones in front, called the pubes ; 
the canal to it is direct, not three inches long. The instru- 
ment, the catheter, as a quill, is adapted to the size, and 
the woman laying on her back, finding the entrance, and 
pushing it backwards and upwards, pushing it gently, in 
the direction where least resistance is made, can readily 
introduce it in herself for the flow of the urine. If there 
be too much sickness for a woman to perform the opera- 
tion on herself, her associate, her nurse, her servant can 
do it. The catheter is to be greased with the mildest oil ; 
the patient laying on her back, it is pushed most slowly 
and gently into the bladder : it is to be held between two 
fingers, and may occasionally be rolled around. The urc- 



97 

ihra makes some resistance, particularly at its entrance in 
the bladder, which is to be overcome with patience and 
gentleness, not violence. In figure the eighth, you see the 
introduction of the catheter. When pregnancy exists, and 
the bladder is thrown up in the belly, as soon as the cathe- 
ter is introduced, it should be held downwards, as in ca- 
theter No. 1. In catheter No. 2, it is supposed that the 
bladder is not so elevated, and it is pushed backwards in- 
stead of upwards. 

In cases of pregnancy, the urethra is compressed by the 
head of the child, and the best catheter is an elastic or 
compressible one, which will yield, or adapt itself to the 
part it has to enter. You should remember, if it be impos- 
sible for you to procure a catheter, and consequently have 
to use a goose quill for a catheter, it should be so tied or 
connected, as to prevent its entire entrance in the bladder, 
where it has sometimes passed, and exposed the patient to 
the necessity of a dreadful operation for its extraction. 
The common catheters have a handle, to prevent this ac- 
cident. I suppose it is scarcely necessary to mention, that, 
on introducing the catheter, you should have a pot or ba- 
sin, to let the urine flow into. Where it is to be intro- 
duced, and the patient cannot discharge the water after- 
wards without aid, it should be introduced twice or three 
times every day. 

Dr. Bard thus writes on this subject. " Introducing the 
catheter, in the female, when the midwife is properly ac- 
quainted with the situation of the orifice, and the direction 
of the urinary canal, is an operation of little more difiicultv 
than administering a clyster ; except where certain obsta- 
cles occur, which are to be overcome, more by patience 
and gently repeated attempts, than by any remarkable skill. 
From motives of delicacy alone, this easy operation ought 



98 

to be in the hands of women ; but what is of much more 
consequence is, that if a man is to be sent for every time it 
may be necessary to perform it, it will generally be ne- 
glected too long, particularly in the country ; to the very 
great injury, and in some instances, danger of the patient. 
The orifice of the urethra or urinary canal, is situated un- 
der the arch of the pubes or share bones, and the canal, 
making a slight curve, ascends very little, and enters the 
bladder almost immediately behind it ; it is not above one 
inch and a half long, so large as to admit a catheter of the 
size of a goose-quill, and so little curved that a straight 
instrument is by some preferred. Having discovered the 
orifice, the operator, standing or sitting on the right side of 
the patient, and holding the instrument in the right hand, 
with the hollow of the curve towards the patient, is to in- 
troduce it ; directing the point at first a little downwards 
and backwards, when gently depressing the hand, raise the 
point a little upwards and forwards : it will almost imme- 
diately enter the bladder, and the urine will flow from its 
extremity. If, however, some little difficulty should oc- 
cur, patience, and gently moving the hand from side to 
side, or upwards and downwards, will overcome it with 
very little or no force ; and with little pain to the patient. 
At any rate, force is never to be used ; it is better to de- 
sist, and make a second or a third attempt : for whenever 
any difficulty presents, it is owing to circumstances not to 
be overcome by violence, which can never do good, but 
may do infinite mischief. In some cases it is best to put 
the instrument, when introduced into the orifice, into the 
hand of the patient ; who, directed by her own feelings, 
will sometimes succeed more easily than any other person : 
a caution, however, necessary to be observed respecting 
the use of the catheter, is not to introduce it unnecessarily j 



99 

or before such remedies as warm bathing, fomentations, a 
clyster, soft mucilaginous drink, have been tried : because, 
when it has once been introduced, it is frequently found 
necessary to repeat the operation, from the increased sen- 
bility it induces on the urethra and neck of the bladder." 

It is proper in this place to remind you, that there are 
many temporary suppressions of urine, not requiring the 
introduction of the catheter. A purge of salts or cream 
of tartar, will generally relieve effectually, as also sitting 
in the warm bath. Such is the habit of urinating at the 
time of evacuating the bowels, that it is seldom the bowels 
are opened in these temporary suppressions, without relief 
to the bladder. Your rule for introducing the catheter, 
should be generally when the bladder is painful, or when 
it may be felt just over the pubes or front bones ; and 
when, by introducing the finger up the birth-place, you feel 
the bladder enlarged. In many cases of fever, there is no 
secretion of urine for a day or two, sometimes longer : it 
is useless in these cases to indulge in the least fear or un- 
easiness. 

From the application of blisters, there is sometimes great 
pain and difficulty in voiding the urine : the parts being 
considerably irritated. This generally wears off in a day 
or two ; particularly if aided by a free use of flax-seed tea, 
or any mucilaginous drink, as gum arabic and water, or 
elm bark tea. The certain remedy for this complaint, is a 
clyster of half a pint of warm water, with fifty drops of 
laudanum. Generally a little starch may be blended with 
it. You ought not to use this injection in cases of high 
fever, unless the pain of the stranguary be very great. 
Before using it, I would always try sitting in a tub of 
warm 1 water, and keeping a rag wet with a solution of 
sugar of lead over the parts inflamed. 



too 

The second internal part below the urinary canal, fe 
called the vagina, or birth-place. At the age of puberty, 
and before copulation, it is from two and a half to three 
inches long, and rather more than an inch in width. Its 
internal surface is lined with glands which secrete consi- 
derable quantities of mucus, particularly during connec- 
tion with the male, and when excited to action, as in the 
disease called zvhites. 

The vagina, or birth-place, is subject, from its commence- 
ment at the edge of the labia or lips, to its termination at 
the mouth of the womb, to inflammation. Sometimes 
matter very much like that of sores is formed. The re- 
medy is a free injection of cold water ; in more violent 
cases, of lead water, or of white vitriol and water. Low 
living and purging always expedite the cure of such in- 
flammations. 

There have been some cases where the vagina has con- 
tracted, forming a stricture, impeding entrance. I knew 
a case of this kind, where the poor pregnant woman was 
left by her injudicious physician to have it enlarged by 
the connection with her husband. The consequence was, 
that the stricture increased till her delivery, when the re- 
sistance was such that she died. The remedy for this 
complaint is gradual distension ; the gradual distension 
may be made by introducing any large body which will 
stretch the passage. The best article for this purpose, is a 
stick made tapering to a blunt point, as large as can enter; 
this is to be covered with waxed linen, made tight around 
it, and three or four times a day should be gently pushed 
up, so as to stretch the parts more and more every day. 
A piece of dry spunge dipped in melted wax, then press- 
ed and pushed in the stricture, and allowed to enlarge by 
the moisture of the part, will be of great service. In cases 



101 

where the constriction increases, the stick for dilating it 
may be worn ; a bandage around the parts will support 
and preserve it in place. 

The birth-place, or vagina, receives into it the mouth of 
the womb, the edges or lips of which project forwards ; 
so that they may be felt, before its connection with the va- 
gina. It has been compared to the inverted finger of a 
glove. This projection of the womb into the birth-place 
should be understood by midwives, as it is from its feel 
that the existence of labour is certainly ascertained. This 
mouth of the womb is called, ridiculously enough, os in- 
ternum, and os tincae ; but you will better understand it, 
by calling it the mouth of the womb. 

The womb is called the uterus ; it is of the size of a 
common large pear ; the largest part upwards towards the 
stomach. It is divided into neck, sides, and fundus. 
The small part, commencing at its mouth, is the neck, this 
disappears in its round sides ; and lastly, the largest upper 
part, called the fundus ; to which the after-birth is often 
attached. 

The womb is a very fibrous mass of considerable thick- 
ness. It is the receiver of what forms the child. It is of 
such a nature, that it enlarges, and grows to the enormous 
size for containing the child and its appendages ; never- 
theless, always retaining the same thickness of its sides. 
It is by the contraction of these fibres that the contents 
are expelled. It receives large quantities of blood, and 
secretes the discharge called the menses. 

o 



102 

The womb is suspended, from each side of the pelvis, 
by a membrane, which allows it to float about considerably. 
Attached to the two opposite sides of it is a small fleshy 
tube, extending near three inches, called the fallopian tubes. 
These tubes terminate in a ragged kind of edge. To each 
side of the pelvis is a small mass of the size of a large 
bean, called the ovariae, or female testicles, as they supply 
the seed the woman yields at impregnation. They have 
little reservoirs, like small blisters, and at every conception 
one of these bursts, and gives up its contents, leaving some- 
thing of a scar in its place. By cutting these out, as in 
the spaying of hogs, the animal is deprived of the power 
of conception. From these circumstances, it has been set. 
tied, that in successful copulation, these floating, moving 
fallopian tubes, all stimulated by the seed of the male, 
have their ragged edges attached to the ovaria, take up 
the contents of one of the little bladders, and carry it to 
the womb for its growth or development. 

Behind the womb and vagina, and attached to the curve 
or hollow of the sacrum, or end of the back bone, is the 
receptacle of the excrement, called the rectum or strait 
gut. By reference to figure the sixth, you will perceive 
the relative situation of these parts better than can be ex- 
plained by writing. 

Having fully familiarized your mind to the relative situ- 
ation of these parts, by the inspection of the figures, you 
will be better qualified to understand the nature of the 
affections of the womb. You observe that it is connected 
to your sides by a membrane at each side of the womb. 
Now this membrane is liable to extension, particularly 



103 

when an ignorant midwife is allowed by ignorant by- 
standers, to pull the after-birth away. This is called the 
falling down of the womb. Its mouth continues to sink 
through the birth-place, till it protrudes out, a most la- 
mentable affliction, since the remedies are but partial. 
They consist in bathing the parts well in cold water, gen- 
tly pushing back the womb, and putting up the birth- 
place a little, oval, oblong ball, called a pessary. This 
may be made of bees' wax, of sponge, silver, bone, or 
ivory, which you may get from the apothecaries, if you 
do not choose to make it yourselves. You push it up the 
vagina while lying on your back, and retain it there by a 
bandage around, as in wearing diapers. It may be taken 
out c.t night after laying down ; but must be pushed up 
in the morning before rising. Cold water poured around 
the hips every morning, will tend to expedite the retrac- 
tion or cure, which in some cases has been perfectly effect- 
ed by perseverance in the use of the pessary, or long, 
round body, worn in the birth-place, to support the falling 
womb. ^ 

The next affection of the womb I wish you to under- 
stand, is what has been termed its inversion, or falling back- 
wards, as represented in figure the seventh. This takes 
place in the early stages of pregnancy, when, after the en- 
largement of the womb, particularly on retaining the 
urine, sometimes from a blow, kick of a child's foot, and 
the like, above the pelvis, the bottom of the womb is 
thrown backwards over the strait gut, so that its mouth is 
turned upwards. This presses on the neck of the bladder, 
and, preventing the evacuation of urine, increases the de- 
rangement by consequent distension. The treatment for 



104 

this accident is very simple ; be sure first to draw off the 
urine with a catheter ; give a clyster to open the lower 
bowels ; then let the woman rest on her feet and head, or 
elbows. In this situation, push the finger, well greased, 
up the fundament, and .you will feel the ball formed by the 
womb, which you are to push upwards. You may also 
have a finger up the vagina, and it is scarcely possible, by 
gently raising the womb with each finger towards its natu- 
ral place, that you can fail of success. On its restoration, 
the woman should be quiet for a week or two, and be cau- 
tious of exposure to the causes, particularly to void her 
urine very often. In some cases of this inversion, there is 
only a difficulty in discharging the urine ; which, as the 
womb enlarges, increases. In every such case you must 
evacuate the urine, and resort immediately to the pushing 
back the womb, as directed. Dr. Denman remarks, that 
it is the middle class in society who are most subject to 
this complaint j the highest and lowest are not ashamed to 
walk out and evacuate their urine the moment they desire 
it. The middle class are so modest, so ashamed, at the 
suspicion they wish to urinate, that they sit, the bladder 
distending till it inverts or turns over the bottom of the 
womb. There is no caution which a married woman 
ought to bear in mind more constantly, than that it is very 
injurious to retain her urine. 

The last derangement of the womb I shall mention is 
one that very seldom occurs. It is when the inside of the 
womb is turned directly outwards, and protrudes out of 
the birth-place as a bag or bladder, immediately after a 
delivery. The cause of this is over straining at delivery, 
but mostly violence in pulling away the after-birth, for 



105 

which any midwife ought to be punished. The remedy is, 
to reduce the patient by blood-letting, if not previously 
enough reduced ; to foment and bathe the womb, so as to 
reduce the inflammation, that it may be replaced. To do 
this, hold the mass grasped in one hand, with the fore-fin- 
ger of the other push back the bottom, as if you wanted to 
push in a bladder, so as to be inside out ; continue gently 
pushing till the inversion is effected, and then the whole 
with a finger may be pushed up the vagina, to its natural 
situation. A medical man ought to attend to the patient's 
health, while she carefully avoids sneezing, bearing down, 
and the like causes of relapse. 

The next disease I shall mention of the internal parts 
of generation, is a dropsy of the ovaria, commencing with 
a small swelling in either, side, gradually enlarging till the 
belly becomes immensely distended. The best treatment 
is to let it alone ; as the melancholy truth has been discov- 
ered, that no cure can be effected by medicine. Sometimes 
it has been known to burst in the womb, discharging all its 
contents through it, so as to relieve the patient. Opening 
the side to evacuate the contents has seldom done ser- 
vice. All the useful that can be urged on this subject is, 
that as there are strong reasons for believing the complaint 
arises from blows or bruises about and above the groin 
and pubes ; females should be careful to avoid them. 

The womb, like every part of the body, is subject to in- 
flammations. The treatment of these inflammations is 
pretty much the same as that of other parts. It is very re- 
markable how much the breasts, stomach, and brain, sym- 
pathize with the womb, when inflamed. The only pre- 



106 

scription, in addition to the general evacuating remedies 
for inflammation, is to apply a lump of ice, or a cloth wet 
in cold water, for a few minutes, several times during the 
day, on the belly, just above the pubes. 

VENEREAL DISEASE. 

1 shall conclude this letter, by giving some account of 
that loathsome disease called the venereal ; which I think 
every mistress of a family ought to understand. There is 
scarcely a day in which some poor female servant does not 
suffer greatly from it ; constantly labouring to conceal it, 
from the shame of exposure to physicians. Were they to 
know that they could readily be cured by one of their own 
sex, they would speedily apply for relief. 

There are two kinds of venereal disease ; one called the 
clap — the other the pox ; very different in their natures, 
and requiring as different treatment. 

CLAP. 

The clap is called the gonorrhoea. It is simply an in- 
flammation from infectious, irritating matter, of the glands, 
lining the vagina or birth-place. It is a disease supposed 
to have been brought on solely by filthy habits. When the 
disease exists, there is an increased discharge from the 
birth-place, of purulent looking matter; sometimes of va- 
rious shades in colour. There is pain in making water 
and often great sensibility of the parts. The cure for this 
disease, is the cure for common inflammation. Confine 
the patient to a low diet, give purges of salts, and use those 



107 

washes which lessen inflammation. I have known this 
complaint to be perfectly cured, by washing every hour in 
the coldest iced water. But the best wash is, twenty grains 
of sugar of lead, or of white vitriol in a pint of water, 
squirted up the birth-place every two hours. The best 
squirt for the injection is a common one, with a large blunt 
point ; the wash to be thrown up with considerable force. 
The common squirts, or female syringes, will answer the 
purpose. By perseverance in the use of these for ten or 
fifteen days, at farthest twenty days, taking extreme care 
to keep the parts perfectly clean, a cure may be certainly 
effected. The rule for discontinuing the wash, is the ces- 
sation of the inflammation and discharge. I have to add, 
that physicians of great respectability have very warmly 
recommended, for every patient affected with this disease, 
to take, in addition to the above prescriptions, thirty or forty 
drops of the balsam of copaiva, on a lump of sugar, three 
or four times a day. Its efficacy is so well established, 
that I would recommend its universal use. 



pox. 



The second venereal disease, which has slain its thousands 
and tens of thousands, is very different from the clap ; and is 
called the pox, or siphilis. In these cases the constitution 
is affected ; and to it the remedies are to be applied. 
About the edges of the lips of the birth-place, there appear 
small sores, called chancres. Their characteristic is, that 
they are always hollow, and appear as if eating inwards. 
Sometime after the appearance of these chancres, from 
five, to forty or fifty days, there comes a tumour in the 
groin, like what is commonly called a waxen-kernel. The 
professional name for these tumours is bubo. 



108 

For the cure of this disease, physicians rely upon mer- 
cury, from beginning to end. The sooner it is commenced 
with the better. On the chancres or sores, about the lips 
of the part, calomel'should be sprinkled twice a day, after 
washing them with soap and water. Half a grain of calo- 
mel should be swallowed three times a day, until the mouth 
becomes sore ; when the quantity should be reductd one 
third. The great secret in salivating, to cure this com- 
plaint, is to keep up the action of the mercury, without 
producing great discharges from the mouth. This is done 
by the patients never lying down when it can be avoided : 
also by guarding against exposures to wet and cold. The 
mercurial action should be kept up from six to twelve 
weeks ; or about one week after the sores heal up. When 
the salivation is excessive, it should be remembered, that 
the cure is not to be effected by sulphur, or by any medi- 
cine : not by the innumerable washes for the mouth. The 
certain means for curing, are keeping the patient up ; 
never having the head down when it can be avoided ; and 
keeping the body in constant exercise. 

This disease is cured by many in preference, especially 
when the calomel affects the bowels, by rubbing mercu- 
rial ointment every night over the arms and thighs, until 
the mercurial action is produced as by the calomel. Some- 
times it is necessary to apply this ointment to the sores. 
A little red precipitate sprinkled on them for a few days, 
often expedites the cure. It is also proper to apply lunar 
caustic to the edges of the sores, whenever they appear 
hard* They should be touched with it in the manner used 
for warts. For the bubo, before it has bursted, a power- 
ful vomit, also a large blister plaster put over it and the 



side to tide abuut $ inches 

frill! /i' 7ntc/c ./ ,/,,_ 




o/'tjir fw7vi 



Fin. 3. 

fliihls Scull ,il-n„hiiiil Nrih 




77,/. 4. 
Sell the,, ti.lci or 
hick JimXOnclle . 
'/iriniuk^^^lnr.initinii at imhmi] hliili 



F(,/. 71. 
S7ieiriii„ /i,ir7.\- if ' ,/c?icl;i/i,>i 




wmmmmm, &&. 7. 

Sl/ciriiitl l/ie lie,,,/ /Men hi, 7, _ tint/ //x nletll/l 
Clrllmi ,/l/lf Madder ,lls/c,„l,,l . ,;„■,;/ /■,, cruel,,,/,',!,! flic mm, 
ui/ll ,i hti/lldcr. l/lfll /l iil/ln,, ili, /iii,,cr'ii/l I lie /iiu', Inliniil mul 
/llislllllt] /lie Tlmti/i nil 1,,\,;ir,ls /'/tldi/er. 




109 

groin, has frequently dispersed it. When they hurst they> 
are verv apt to become dangerous, and in that case a phy- 
sician ought always to direct the treatment. 

It is not to be denied, that there are some cases of this 
disease extremely difficult ; nay, impossible to be cured. 
The matter acts upon the body as a poison, baffling the 
prescriptions of the ablest physicians, I would enjoin, 
whenever the case becomes obstinate, to call in a physi- 
cian, for the treatment of the first symptoms as well as the 
secondary. The secondary symptoms never fail to make 
their appearance, when the salivation has not been continu- 
ed sufficiently long to cure the constitution. These are 
pains on going to bed, in the muscles and in the bones, 
enlargement of the bones, sore throat, destruction of 
nose, he. 



.***" 



Ill 



LETTER VI. 



Contents. The womb in pregnancy— history of its en* 
largement — symptoms, and sign of conception — conduct 
during pregnancy — diseases attendant — inflammation of 
bowels — sickness and vomiting — heart-burn — colic- 
fainting — swelled legs— flooding — abortion—sure of 
barrenness. 

From the description of the organs of generation, I 
proceed to explain their functions. Every woman in 
child-bearing becomes of more interest ; another is de- 
pending upon her, and none but the most indifferent ob- 
servers fail to feel a deep solicitude for their prosperous 
delivery. 

At the sexual intercourse between man and woman, 
when the circumstances have been favourable for concep- 
tion, the seed of the male is supposed to enter the womb of 
the female, and uniting with the seed of the woman, comes 
down through the tubes called the fallopian, and forms the 
commencement of our bodies. At the same time is form- 
ed what is necessary for the growth ; that is, a coat or cov- 
ering to include the whole, and lining the womb, called the 
membranes ; also, a fleshy substance, almost like the liver, 
called after- birth, or placenta. This after- birth receives 
and prepares the blood supplied by the womb for the 
child ; there is a tube passing from the after-birth to the 



112 

navel of the child, called the umbilical or navel cord ; the 
tube isibr the purpose of the circulation of blood between 
the mother and child ; lastly, is also formed a liquid, call- 
ed among women, " the waters," resembling in its na- 
ture the white of eggs, a fluid in which the child moves. 
Thus the contents of a pregnant womb, formed in minia- 
ture at conception, are the child, the waters, the mem- 
branes holding them, the navel cord, and the after-birth. 
The natural history of their growth is thus stated by 
count Buffon. " Immediately after the mixture of the 
seminal fluids, it is probable the whole materials of gene- 
ration exist in the womb, under the form of a small globe. 
This globe is formed by a delicate membrane, which con- 
tains a limpid liquor, very like the white of an egg. In 
this fluid may be seen some small fibres, which are the 
first rudiments of the young. Upon the surface of this 
globe there is a net work of delicate fibres, which extend 
from one end to the middle, forming the beginning of 
what is termed the placenta, after -birth, or secundinesj, 
which is the part connecting the child to the mother. 

" Seven days after conception, parts of the child are- 
distinguishable to the naked eye ; very imperfect, ap- 
pearing as of a clear jelly, though of some degree of so- 
lidity. The head and trunk may be easily distinguished, 
it being of an oblong figure, the trunk being longest and 
most delicate. Some small fibres, resembling a plume of 
feathers, issue from the middle of the child, (the navel,) 
and terminate in the membrane by which the whole is. 
enclosed. These fibres are the rudiments of the tube con- 
necting the young to the after-birth, called the umbilical 
cord, or navel string, which connects to the after-birth, or 
placenta. 



113 

" Fifteen days after conception, the head and most pro- 
minent features of the face are apparent. The nose re- 
sembles a small elevated thread, direct over a line which 
marks the division of the lips ; two black points repre- 
sent the eyes ; and we see two holes in place of ears. The 
body has also acquired some growth ; on each side pro- 
jections appear, which are the rudiments of the arms and 
legs. In three weeks, the body is a little enlarged ; both 
the arms and legs are visible. The growth of the arms is 
quicker than that of the legs ; and the fingers separate 
sooner than the toes. The internal parts now appear ; the 
bones seem as threads. The ribs are disposed on each side 
as fine threads ; the arms, the legs, the fingers, and toes, 
are also represented by similar threads. 

" At one month, the young, called the fcetus, is an inch in 
length. It takes a curved posture in the middle of the 
liquor that surrounds it ; and the covering or membranes, 
in which the whole is included, are increased and thicken- 
ed. The whole mass is about an inch and a half in length, 
of an oval or egg shape. All the parts of the face may 
be seen ; the body is visible ; the haunches and belly are 
prominent ; the hands and legs are formed ; the fingers 
and toes are divided ; the skin is thin and transparent ; 
the parts in the belly resemble a knot of fibres ; the ves- 
sels are as fine threads ; the bones are still soft, only a few 
places beginning to assume some degree of solidity. The 
vessels forming the navel cord extend in a straight line. 
The after-birth now occupies less space than in the begin- 
ning, though its solidity has increased, and it has become 
thicker than the covering or membranes covering the 
whole. 



114 

" At the end of six weeks, the foetus is about two inches 
long ; the form is more perfect, only the head is longer in 
proportion to the other parts of the body. About this 
time the motion of the heart is visible ; in fifty days it 
was perceived to beat for a considerable time after the 
fcetus was extracted from the womb. In two months it is 
more than two inches in length ; the formation of the bones 
being much more visible. In three months it is near three 
inches in length, and weighs about three ounces. Some 
women affirm they have felt its motions about this time ; 
but it is difficult to be certain ; motions in the neighbourhood 
are mistaken for those of the child. Yet the sensations 
excited by its first motions, depend more on the sensibility 
of the mother than on the strength of the child. Before 
the end of the third month, the head is bent forward, the 
chin rests on the breast ; the knees are elevated, and the 
legs folded back upon the thighs. One of the hands, of- 
ten both, touch the face. Afterwards, as it acquires more 
strength, it perpetually changes its position ; though, in 
general, the head inclines downwards." 

It is at the fourth month, that generally the mother feels 
the motion of the child within, which is called quickening ; 
and which in some produces very considerable alarm j 
sometimes sickness, hysterical symptoms, vomiting in the 
night and in the day, either repeated or not, for days. This 
motion is the only infallible symptom of pregnancy ; and 
generally terminates the unpleasant sickness and diseases 
preceding. 

After this the development or growth of the child be- 
comes much more rapid than in the beginning. At first 



115 

the waters, membranes, and after-birth, were much larger 
in proportion to its size, than at this time, and every day 
this difference is increased, till the birth, when, in bulk, 
they appear very inconsiderable in comparison with the 
child. 

About the time of quickening, the womb may be felt 
floating, as it were, in the lower part of the belly ; particu- 
larly if the woman relax the surrounding parts by not ex- 
erting them. Before this, while the womb is retained in 
the pelvis, upon putting a finger up the birth-place, while 
the woman is standing, the mouth of the womb may be 
felt, lower than in a natural state, as its additional weight 
causes it to descend. This is very perceptible for some 
weeks after conception. After this it enlarges, and ap- 
pears ascending up in the belly, till it grows so large as to 
be unable to descend through the pelvis. 

After conception, the breasts become rather smaller ; 
but in the third month they enlarge ; the nipple is sur- 
rounded with a brown circle, and frequently a milky fluid 
can be pressed out. The belly at first becomes somewhat 
flat, but very soon increases in size in the lower part. In 
the fifth month, the womb begins to render the belly hard^ 
and may be felt as a ball rising to the middle point between 
the pubes and navel. In the seventh month it reaches to 
the navel ; in the eighth, half between that and the breast 
bone ; in the ninth it nearly touches that bone, particularly 
in first pregnancies, when the resistance of the belly pre 
vents the hanging down, as in following pregnancies. 

With some persons, generally in the best cases, after the 



116 

expiration of nine calendar months, or forty-two weeks 
after menstruation ceased, the child is so well made, that 
it is able to live without connection with the mother ; 
making allowances for a few days variation. The delivery, 
effected by the contraction of the fibres of the womb, 
which are not designed longer to bear the irritation of such 
distension, takes place, sometimes not till the hour of de- 
livery, sometimes a few days, at others two or three weeks ; 
the woman feels an increase of anxiety, busies herself for 
the reception of the infant, moves with difficulty, and fre- 
quently complains of restlessness, and pains in the back 
and loins. As the period approaches, her belly subsides 
most, in the most favourable cases : her discharge of urine 
is affected, sometimes suppressed, at others not to be re- 
tained ; occasionally a lax ; generally she is rather costive ; 
and she perceives a discharge of mucus from the vagina 
tinged with blood. But the history of this expulsion will 
be reserved till the next letter. 

As was remarked, the liquid called " the waters," in a 
healthy state, resembles the whites of eggs. Among ma- 
ny, however, this appearance does not exist, and the wa- 
ters become of various qualities ; sometimes extremely of- 
fensive. The quantity of the waters is also subject to 
great variations at birth; in some cases there is scarcely 
half a pint, in others half a gallon has been found. 

The means nature provides for the growth of the child 
are very remarkable. As stated in the commencement, 
the growth is entirely effected through the after-birth or 
placenta, which prepares the blood in the proper condition,- 
as our lungs do for respiration ; and then it is transmitted 



117 

by the umbilical or navel cord to the child. The after- 
birth is a fleshy substance, its edges thin, differing in weight 
from one to two pounds ; it adheres to the sides of the 
womb, often to its upper part, called fundus, and receives 
the blood from the womb. 

The navel, or umbilical cord, is composed of two veins * 
which come from the placenta, and an artery coming from 
the child, twisted round so well, as to resemble one cord. 
The blood carried through the veins enters at the navel of 
the child ; thence, in proper vessels, is conveyed to the 
heart, and by it diffused over all the body for its growth. 
It returns from thence, and, by the power of the heart, is 
sent back through the artery of the cord to the placenta, 
©r after-birth, where it again undergoes the change neces- 
sary for fitting it for the use of the child. The length of 
the cord through which it passes varies considerably. It 
has been known not to exceed six inches, and in other 
cases to be thirty inches. About eighteen inches is its or- 
dinary length. 

Some women, on conceiving, feel such an alteration in 
the state of the stomach, or in their sensations in general, 
as apprises them of their situation. " But, usually, the 
earliest notice is afforded by the obstruction of the month- 
ly discharge. T* his is an invariable effect of conception ; 
but it must be recollected, that it may take place from other 
causes. Early after conception the stomach is affected, 
heart-burn, sourness on the stomach, want of appetite, dis- 
gust at the usual food, and sometimes a craving for things 
formerly not desired. Frequently the woman is sick in the 
morning, vomiting after getting up, though some are only 



118 

sick in the afternoon, sometimes troubled through the day 
with qualms, faintiness, and inclination to vomit. Some 
have a constant desire to spit, have the tooth-ache, cough, 
and other affections of variety of kind and duration, dif- 
fering in every case. 

In some cases, the complexion greatly suffers in preg- 
nancy, the features being affected, as in cases of children 
with worms ; in other cases, the looks are much improved. 
Sometimes the pulse is as common, though generally it is 
quicker. Perhaps there is no woman who does not under- 
go such an alteration in parts or the whole of her system, 
after conception, as would enable an attentive observer to 
ascertain the fact. But it is enough for you to know, that 
there is no one certain sign of pregnancy, excepting the visi- 
ble motions of the child. In all those cases where doubt 
exists, and the object is to ascertain the fact, for purposes 
of punishment, both men and women should unhesitatingly 
decide on the safe side, suspending all judgment, till proof 
be unquestionable. 

As this is enough of the natural history of the contents of 
the womb, I proceed to remark on the rules women should 
observe during pregnancy j and the treatment of some of 
the most common complaints to which many are subject. 

In order for you to discover the very best modes of con» 
ducting yourselves during pregnancy, you have only to 
make a few common observations, and exert a little com- 
mon sense. The course pointed out by nature, pursued 
by all the pregnant animals, from inclination ; by the wo- 
men in the lower classes of society,, and in the savage 



119 

state, from necessity, is the course you must discover, is 
the proper one for you to pursue, in order to ensure suc- 
cessful child-bearing. It is known that all our domestic 
animals ; mares, cows, sheep, and the like, produce the 
best young in the largest pastures ; and that women mov- 
ing about in the country have much finer children than 
those leading sedentary lives in town. Is it necessary that 
I should press on you the truth, that moderate exercise in 
the open air, not by starts, but long continued, with sim- 
ple diet, regularly taken, so necessary for the health of 
your bodies at all times, is more especially so, during the 
critical period of child-bearing ? It is to be regretted that 
so many pregnant women lead such inactive lives, not only 
on their own account, but on account of their children ; 
for doubtless, it is owing to the sluggishness of the ac- 
tions of the mothers that so many in society are mere 
stupid masses of flesh and blood. Among the Indians, such 
want of genius could not be found. Pray believe the de- 
claration, that it is necessary to take the trouble, to make 
efforts to secure what we want. If you desire health, 
you must take the trouble to walk or to ride about every 
day : to breathe a fresh, pure air by night and day, as 
well for your own as your infant's sake. You must con- 
fine yourself to a plain, simple diet, abstaining from every 
thing stimulating; keep your bowels regularly open, and sit 
daily in cold water. Your sleep should be regulated with 
great attention ; night companies abandoned, and all ex- 
posures, particularly to such as may suddenly alarm you. 
Your dress should be loose, without tight bandages 
binding any part of you. I will not speak of your lacing 
yourselves, confining your waists, compressing your 
breasts and the contents of the womb ; because the laws 



120 

are defective in their operation, for not giving prompt pu- 
nishment to the mother ; who, from feelings of vanity, be- 
comes accessary to deforming and destroying the unfor- 
tunate contents of her womb. 

I again give you the caution of voiding your urine fre- 
quently, and particularly, on having the least desire; which 
was pressed while treating of the womb. You should re- 
fer to it, and remember that the mischiefs of inattention 
may be incalculable. 

As of next importance to the evacuation of the blad- 
der, is the daily evacuation of the bowels. What I have 
urged on this subject, in the second letter, I would press 
with increased zeal on pregnant woman. It is of ten 
times the importance during pregnancy. The womb rest- 
ing on the lower gut, lessens the ability to evacuate ; but 
persevere, and do not remit, till daily at the same hour 
your bowels are opened. Some have neglected this to 
such a degree, that they have had a confined column of 
excrement in their bowels of great length, requiring that 
they should be turned up, and have it scooped out with the 
handle of a spoon. If you cannot have a natural evacu- 
ation daily, from your own efforts, take an injection ; there 
will be in the end a real saving of trouble by the ope- 
ration. 

The system of women during pregnancy, is always more 
or less inflammatory ; even among the emaciated. Their 
bodies convert the fat of every part into the circulating 
blood ; which, when drawn, has the buffy coat, character- 
istic of the high action of their bodies. There is generally 



121 

increased irritability of temper, marked by great fretfui- 
ness : requiring soothing, not provoking returns. Those 
who are well should commiserate them ; and those preg- 
nant should labour to restrain their petulance and violent 
temper ; constantly bearing in mind, that their acuteness 
of feeling arises not from any hard circumstances in which 
they live, but rather from a morbid action in their bodies. 

This irritability of the system and mind may be lessen- 
ed, by a moderate use of the mild tepid bath. The hot 
bath has produced abortion ; but sitting in a long vessel of 
milk warm water, covering thighs and legs, having it gently 
poured around the belly, the skin slightly rubbed with a 
soft hand, will have a strong tendency to preserve and 
equalize the healthy action of the womb and adjacent parts. 

Some women complain greatly of pain in the pubes or 
front bones, particularly in advanced pregnancies. The 
womb hangs over the pubes, presses on them, and pro- 
duces this uneasy feeling. This complaint may be lessen- 
ed by the above bath ; but most by wearing a bandage 
around the shoulders, extending down each side and 
around the under part of the belly, so as to support it. 
This at the same time prevents the belly from hanging 
over, and becoming so pendulous after delivery. The ap- 
plication of the bandage should be when the person is ly- 
ing down : it should be very wide ; several inches where 
the belly rests on it ; and drawn so as merely to be felt in 
that position. When the woman rises, the abdomen will 
rest on it, and great support will be derived from it through- 
out the day. 

Some women have the lower bowels inflamed by the 



122 

pressure of the womb, and also a constant desire to void 
the excrement. The relief for this is moderate blood- 
letting, sitting in a tub of warm water, and a slight purge 
of salts or oil ; rest, and laying on the belly will be of ser- 
vice. Sometimes the piles are particularly distressing in 
pregnancy, to be relieved by the means pointed out, while 
treating of their cure in the second letter. 

SICKNESS OF STOMACH. 

The next complaint I shall mention, is sickness of sto- 
mach and vomiting. Generally this does no harm ; but 
when excessive, it is to be relieved by moderate bleeding, 
by keeping the bowels open, by cupping, or applying leech- 
es to the stomach, and rubbing laudanum over it ; also, 
with the application of hot cloths to it. The saline 
draught, made of lime juice, and salt of tartar in effer- 
vescence, is very good. Soda water has been drank with 
success ; lemonade, and the like common articles. The 
internal use of laudanum should be avoided. 

HEART BURN. 

For heart-burn, the general prescription is prepared chalk, 
a tea spoonful mixed in water or milk at a dose, every two 
or three hours. A little soda, potash, or magnesia, may 
occasionally be taken ,• sometimes gum arabic and liquo- 
rice have done service, The best remedy is a few drops 
of spirit of hartshorn. I have known large quantities of 
warm water quickly drank, to relieve the symptoms ; gen- 
tle vomiting in distressing cases might be tried, excited by- 
putting the finger down the throat. A little bleeding has 
sometimes done good ; and regular exercise never fails to 
produce the like effect. 



123 



COLIC. 



In cases of colic, or pains in the bowels from flatulence , 
When violent, blood-letting should be resorted to, if not at 
once relieved by injections of warm water : a moderate 
purge of oil, salts, manna, or cream of tartar, should al- 
ways be taken. The bowels, during colic, should con- 
stantly be kept open, by keeping a piece of soap in the 
fundament, as recommended in the second letter. Sitting 
in a tub of warm water, or applying hot cloths wrung out 
of hot water, will alleviate the pain. 

* TAINTING. 

In fainting fits, the patient should be kept laying down, 
exposed to cool air. Moderate bleeding is proper, with 
slight purging. When the sickness is very great, a mouth- 
ful of wine or spirit affords a temporary relief. 

SWELLED LEGS. 

Swelled legs are very common in the pregnant state . 
Towards the last, they are often a source of pain and 
great uneasiness. They are produced by the pressure of 
the distended womb on the vessels returning the fluids 
from the lower extremities. Generally they disappear at 
night, and return daily, particularly in the evening. For- 
tunately they are not dangerous. A recumbent posture 
lessens the swelling considerably. Moderate bleedings 
occasionally are requisite. No local remedies afford half 
as much relief as wearing laced stockings ; sometimes the 
common stockings, lengthened so as to reach to the body. 



1£4 

and fitting very tight, answer sufficiently ; these resist the 
distension, and support the parts ; delivery always termi- 
nates this disease. 

During pregnancy women are always subject to the 
same complaints as in the unimpregnated state. For their 
treatment professional characters should always be con- 
sulted. They should bear in mind that their systems in 
this situation are very inflammatory ; and that the reme- 
dies ought not to be so very strong as in other situations, 
particularly when applied to the bowels. Powerful pur- 
gatives should never be taken. All that shocks the 
system should be carefully avoided. 



CRAMP. 

Doctor W. Moss, a most excellent and judicious writer* 
of Liverpool, states, on this subject, that " the cramp is 
not an uncommon attendant on pregnancy, and will attack 
those at this time, who seldom or never have it at any 
other. It seldom comes on before the fourth month, and 
is most common at the latter parts. It most frequently 
attacks in the night, in bed, in the legs, sometimes in the 
thighs, hips, and belly. 

" Getting up, and standing barefoot on the cold hearth, 
is a common remedy, and, so far as I have observed, is a 
safe one. In cases of costiveness, keeping the body open 
will frequently mitigate it j as also, bleeding, when it is 
severe and frequent. It will oftentimes be rendered more 
severe by unusual exercise or fatigue. If instead of the 
usual way of rubbing the cramped part with the hand, the 



125 

part is strongly pressed or grasped with the fingers and 
hands, more present and temporary relief will be had." 

Pouring cold water on the part, rubbing with a woollen 
eloth briskly, and sleeping under fewer bed clothes, will be 
found of service. 



FLOODING. 

The most important and fatal of all complaints to which 
pregnant women are exposed, is what is called flooding, 
or loss of blood from the womb. This is brought on by 
alarms, falls, jolting, over-action, and sometimes from no 
visible cause. The membranes lining the womb, particu- 
larly the afterbirth, separate from their adhesion to the 
womb, and the large blood-vessels entering into it, dis- 
charge the blood, which then passes through the mouth of 
the womb in large quantities. The complaint is the more 
alarming, as the danger is of the most imminent kind when 
least apparent. Death frequently ensues with very incon- 
siderable warning. 

The treatment of flooding requires much attention and 
still. In all cases, medical aid should be had the moment 
the disease appears. If it cannot be had, you must make 
the patient continue in bed, as cool, and with as much 
fresh air as will be tolerably comfortable. In the beginning 
she should always be blooded freely, rapidly, so as to pro- 
duce fainting, which should never be checked, as it is at 
this moment that those clots of blood are formed, which 
put a stop to the flooding. If no one can be had to bleed 
directly, bandages around the arms and thighs, so as not to 
hinder the pulsation, may be applied until the arrival of a 



126 

bleeder. Cool air being admitted, the bowels should bt 
opened with a clyster of cold water : every thing heat- 
ing, as warm clothing, stimulating drinks and diet should 
be avoided. If the blood continue to flow considerably, 
stuff up the birth-place a cloth to stop the passage. A cold 
wet cloth on the belly will tend to stop the discharge : this 
should be renewed every two or three hours ; a bag of ice 
is the best application. These cold applications (sitting in 
cold water has been found good) should not be continued 
so long as to produce chills. If the bleeding still continue, 
two grains of sugar of lead should be given every hour, un- 
til it ceases, or until five Gr six doses are taken : about 
twenty grains in a quart of water, one fourth injected in 
the bowels, and the remainder used in washing the birth- 
place, will expedite the cure : it may be repeated two or 
three times. Almost always, these remedies relieve the 
discharge for the present. The great danger is in its re- 
turn. In order to prevent the return, no matter how 
well the patient feels, she must continue in bed two or 
three weeks, cool and quiet, and ready at all times to ap- 
ply the cold wet rags up the birth-place, in case of return. 
I warn you not to disregard this cautious conduct ; if you 
do, ten chances to one, you are dead without an hours 
warning. 

When the flooding returns, in great degree, in spite of 
all efforts to prevent, the woman becoming extremely pallid, 
showing excessive loss of blood, but one remedy is left, 
and that is to produce an immediate abortion. Unless the 
danger be very pressing, the advice or direction of a phy- 
sician should be taken before the destruction of the. child. 
It should, however, be always remembered, that the life of 



12/ 

the child is not to be compared with that of the mother. 
A forced delivery being determined on, a woman with 
small hands should be the operator. 

The patient should lay on her side, her thighs drawn 
up near her belly, with a pillow between them. The wo- 
man operating should grease her right hand well with the 
mildest lard or oil, and folding her fingers together as 
round as possible, should very gradually introduce or push 
them up the birth-place, gently dilating or extending the 
parts as she carries her hand forwards. When her hand 
arrives at the mouth of the womb, she will perceive its 
edges or lips, and between these she must gently insinuate 
her finger, so as to pass through the membranes holding 
the waters : this being done, the waters immediately flow 
out, and the womb begins to contract. If the flooding 
cease in this stage, it is well to stop ; but if the womb ap- 
pear relaxed, not contracting, it is necessary to go on, gra- 
dually insinuating the fingers in the mouth of the womb, 
then opening them gently so as to enlarge it ; then still 
gradually introducing the hand and arm, and passing the 
head of the child, feel for a foot, which you will distin- 
guish by the heel, the toes, and the difference in its feel 
from the hand, if you hold it as if to shake hands. After 
taking hold of the foot, it is to be brought down to the 
birth-place. But the following from Dr. Bard, is a better 
description of the operation than I can give. " Introduc- 
ing the hand into the womb, turning the child, and deliver- 
ing by the feet, is an operation seldom attended with much 
difficulty or danger, provided it be performed early, be- 
fore the waters of the womb are fully discharged, and with 
due deliberation and caution. Whenever it is determined 



128 

on, let the woman be brought down to the edge of the bed, 
still lying on her side, or, as I have generally found most 
convenient, on her back ; her hips a little raised, and her 
feet supported on the lap of an assistant on each side ; 
whilst a double sheet spread under her, over the laps of 
the assistants, and that of the accoucheur, (sitting on a low 
seat before her) protects her from cold, and another thrown 
over her, forms a decent covering. The hand then lubri- 
cated with good oil, or fresh hog's lard, and the fingers 
collected into a cone, is to be gently and slowly introduced, 
through the vagina to the womb ; which, in some wo- 
men a little advanced in life, especially in case of a first 
child, may make so much resistance as to require an hour 
or more ; employed in gradual and cautious efforts to 
overcome ; when the circumstances of the case will admit 
of such delay. The internal orifice is next to be dilated, 
by introducing first one finger and then another, until by 
slow and gentle attempts it will admit the hand ; remem- 
bering always, that by the natural contractions of the 
womb, the orifice will be more safely and easily dilated, 
than by the finger. Whenever, therefore, the pains occur, 
our efforts to dilate are to be suspended, and the pains are 
to be permitted to produce their effect on the hand. When 
the pain ceases, a gentle distension is again to be made, 
which will probably soon occasion another pain ; which is 
again to be permitted to produce its effect. And on some 
occasions, just as the hand is passing into the womb, it is 
to be opened and laid flat, lest a violent contraction on the 
knuckles, should injure, perhaps rupture the neck, which 
is the part most liable to such an accident. The orifice of 
the womb being sufficiently dilated, if the hand can then 
be easily passed over that part of the placenta which has 



129 

been already separated, until it reach the membranes, that 
is to be done ; and breaking the membranes, it is to be 
immediately passed into the womb. Bat if we cannot 
readily pass the separated portion of the placenta, and the 
flooding be profuse, it may be necessary to pass through 
the placenta ; which is less dangerous either to the mother 
or child, than to separate a larger portion, by passing the 
hand between it and the uterus. The hand being intro- 
duced into the womb, the neck will generally cling so close 
round the wrist as to prevent the escape of much water, 
and we shall find room to act with freedom ; and as the 
same pressure generally suspends the haemorrhage, we may 
take time for deliberation. It is therefore generally pro- 
per at this period to rest a few minutes, to recover any fa- 
tigue we may have sustained ; and to refresh the woman 
by some proper drink, whilst we deliberate on the circum- 
stances of the case, consider the position of the child, and 
the readiest way to get at the feet. It will be recollected, 
that the most natural presentation is the most common ; and 
that in that case, the child's head is at the brim of the pel- 
vis, with the face and belly to the back of the mother, the 
knees bent to its breast, and the feet towards the fundus 
uteri. As therefore, the child must ultimately be turned, 
this may be the best time to push the head and shoulders 
up towards the fundus, and to turn the face of the child 
to the back of the mother ; which is most easily done 
within the membranes, and by which the feet will be 
brought within reach of the hand ; and having secured 
them, they may be easily brought by a waving motion 
into the vagina. It is always best, when it can easily be 
done, to bring down both feet ; one however will answer, 
and generally the child can be turned and delivered by 



130 

one, with nearly as much ease as by both. In bringing down 
the feet, bend them a little to either side where you find most 
room, and remember always to desist during the action of a 
pain, and proceed again during the interval. After this we 
may take the assistance of the pains in delivering the hips 
and body of the child ; cautiousjy extracting during the 
pains from side to side, and from pubes to sacrum. As the 
hips are brought down, carefully consider again how the 
child lies in the womb ; with its belly to the belly or back 
of the mother ; and take care, if it shall be necessary, to 
turn it gradually, so that by the time it shall be delivered 
iis far as the arm pits, the belly of the child shall certainly 
be to the back or the mother, which is the position in 
which the arms and head can be most easily delivered. 
And now, or rather somewhat before this, examine the 
navel string, and occasionally pull it down a little, so as to 
prevent ks being put on the stretch. If the pulse in the 
navel string be strong, and the haemorrhage suspended, we 
may still proceed with deliberation, and take the assistance 
of the pains in accomplishing the delivery. But if the 
pulsation has ceased in the cord, or if the woman floods 
freely, either the child or the mother may be lost by delay ; 
and it becomes necessary to finish the delivery as soon as 
we prudently can. If therefore, the child's arms make any 
resistance, introduce one finger under the pubes, and car- 
rying it along the child's arm to the elbow, pull that down 
a little, then go on to the wrist, it will easily turn down in- 
to the hollow of the sacrum, and be delivered ; the other 
arm will be still more easily delivered in the same way. 
But let it always be remembered, that caution and dexte- 
rity are more necessary than force ; by which, unskilfully 
applied, there will be great danger of breaking the child's 



131 

arms. Having delivered the arms, lay the body of the 
child on your left arm, and passing two fingers of that 
hand into the vagina, introduce them into the child's 
mouth, and draw the lower jaw down a little, so that, if 
possible, you may extend the fingers above the mouth 
along the child's nose ; then placing the fingers of the 
right hand across the child's neck, again cautiously ex- 
tract during the pains, sometimes pulling down towards 
the sacrum, again up towards the pubes, and from side to 
side ; and again pushing down and backwards towards the 
hollow of the sacrum, so as to free the occiput from the 
pubes. The chin being brought down as low as the fo- 
shette, stand up, and raising the back of the child towards 
the belly of the mother, the face will turn out from the 
perineum, and the delivery be finished. 

" In giving this description, I have purposely supposed 
the most favourable circumstances that occur in a case of so 
much importance : the haemorrhage to be restrained by the 
introduction of the hand : and the greater part of the wa- 
ters to be retained by the wrist plugging up the orifice of 
the womb ; that I might describe the successive steps of 
the operation minutely and distinctly : but we must not 
flatter ourselves, that this will generally, or even frequent- 
ly, be the case. There are few situations of greater terror 
or alarm, than a woman flooding at the latter end of preg- 
nancy ; and we are frequently called on to decide instant- 
ly, and to act promptly ; yet we must never suffer our- 
selves to be confused or hurried ; for, even during the 
operation, many occurrences may happen, which call as 
much for cool reflection, as for prompt and ready execu- 
tion. Of these I shall take notice in describing those pre- 
ternatural cases in which thev are most likelv to occur. In 



133 

many of these cases, women are so much exhausted by 
loss of blood, that even after a safe delivery, they require 
great attention to recruit their strength and save their 
lives. Rest, promoted by small anodynes, in some cordial 
julap, such as spirituous cinnamon water, or what can al- 
ways be had, good toddy with nutmeg, are the remedies 
first called for : these must be succeeded by small portions 
of nourishing diet, frequently repeated, and by tonics, in 
which an infusion of the Peruvian bark and cinnamon in 
claret agreeably sweetened, makes a pleasant and efficacious 
mixture. The after-birth is never to be hurried." The opera- 
tion, altogether, may appear difficult to perform, but it is not. 
The exertion of a good sound sense will ensure success. 
Many women have performed the operation on themselves, 
to get rid of a disgraceful pregnancy : they have succeed- 
ed by simply introducing the finger between the lips of 
the womb ; so as to burst the bag of waters, and immedi- 
ately an abortion comes on. When the murder is deter- 
mined on, it is certainly better to do it, so as to save the 
mother's life for repentance, than that she should be de- 
stroyed, as is often the case, by taking drastic purgatives to 
efFect this object. 

However, of late there has been discovered an article 
called ergot, which is the musty, dark looking heads of rye, 
found in most fields of rye when nearly ripe. These heads 
reduced to powder, are used, it is said, on good authority, 
for producing abortion, without injuring the mother. The 
dose is twenty grains, mixed in a little molasses and water ; 
and it is stated, that the operation is such, that immediate- 
ly after being taken, the contraction of the womb com- 
mences. Whether this medicine will supersede the man- 



133 

aer of producing the delivery above pointed out, remains 
to be determined by experience. Even if this medicine 
succeeds, agreeably to expectation, I would prefer the 
mode of suppressing the flooding by perforating the mem- 
branes with the finger, since without introducing the hand 
in the womb to turn the child, as above described, this 
perforation or bursting of the bag of waters has been suc- 
cessful ; more perfectly so than I supposed, on writing the 
first part of the operation for turning. I would therefore 
always recommend for flooding in excess, the perforation 
of the membranes with the finger, before attempting to turn 
the child. 

Abortion. Connected with floodings, during pregnancy, 
is abortion, or premature discharge of the contents of the 
womb, ending in its destruction. Not having had any par- 
ticular experience on this subject, I give the best brief 
view of it from Dr. Bard ; a few words of which are 
changed. 

" Abortion happens frequently, and deprives women of 
their health and happiness. Very strong and very weak 
women are most prone to it ; but the numbers of the strong 
bear no proportion to those who are of delicate constitu- 
tions ; the numbers of active country women, to the more 
indolent and inactive inhabitants of cities ; the number of 
women of good sense, of calm and steady minds, to the 
weak, irritable and passionate : hence a most important 
lesson may be learnt, that ^ood health, and a good educa- 
tion, are the best preventives. It then, in a great de- 
gree, depends upon mothers, upon the care they take in 
rearing their girls, restraining the indulgence in all pas- 
sions, to lessen this great and common evil* 



131 

u Another observation is, that women who have once 
miscarried, are apt to miscarry again at the same period, 
from the same causes, and with the same symptoms. So 
that if the habit be once acquired, it becomes difll.-ult to 
remove. Hence the importance of great care in young 
women, not to miscarry in their first pregnancy ; and the 
propriety of particularly guarding a^inst the causes that 
produced it at first, in all following pregnancies. 

" Miscarriages are most apt to occur between the eighth 
and the twelfth week, and from the fifth to the seventh 
month, periods which will require particular attention ; 
though a prudent care be at all times necessary, as the 
cause of the miscarriage may, and commonly does exist at 
a much earlier period than that at which the abortion oc- 
curs. 

" The causes of abortion may be reduced to the death 
of the child ; to the separation of the bag or membranes 
enclosing it, from the womb, and to the disordered con- 
traction or action of the womb. 

" That the child may die, independently of any disease 
in the mother, h*s b en proved by many cases in which a 
healthy mother has discharged it, with marks of consider- 
able disease. 

u A frequent cause of abortion is the separation of the 
membranes lining the womb, and surrounding the child. 
Th- extreme delicacy and tender structure of the vessels 
connecting this membrane to the womb, especially in the 
early months of pregnancy, renders the separation not very 
difficult, :,\ slight causes : hence miscarriages happen most 
frequently between the eighth and sixteenth week. Yet 



133 

the cause operates much earlier ; for sometimes, before a 
small rupture occurs between the after-birth, or any part of 
the membranes and the womb, the blood is gradually ef- 
fused ; thereby increasing the separation, till the womb, be- 
ing excited to action, expels its contents. This cause of 
miscarriage cannot be detected before labour, and is proved 
only by the expulsion of a quantity of coagulated blood, 
immediately before or after the delivery. The causes of 
the separation of the membranes from the womb, are, gene- 
rally, too much fulness of blood in the system, arising from 
free living and little exertion, indulgence in excessive joy, 
sudden or violent exercise, awkward postures, stimulating 
food or drink, costive habit, and excessive passions. These 
operating most directly after marriages, require that great- 
er attention should then be paid by women to guard against 
them. The remedy for this state is moderate bleeding, 
keeping the bowels open, and temperance and regularity 
in every action. 

" The disordered action of the womb itself, is a great 
cause of abortions. Disorders or affections of any part 
in the neighbourhood are apt to produce it. This points 
out the propriety of promptly treating any affections about 
the pelvis in the most judicious, mild manner. The warm 
bath and bleeding are the great remedies, and should be 
administered by the ablest physicians for all the complaints 
of these regions, in pregnancy. From the recurrences of 
abortions the womb is very apt to get in such a state, that 
it will not enlarge beyond a certain size, and as soon as it 
arrives at this size, it contracts, and expels its contents, 
as if from habit. This affords a powerful reason for do- 
ing all that can be done to prevent the formation of the 
habit, by preventing the first abortions. 



136 

" The signs of approaching miscarriage are, absence of 
the morning sickness, subsidence of the breasts, a dis- 
charge of blood, or of water from the birth-place, and re- 
gular labour pains. A coldness of the belly, or sense of 
weight, and cessation of motion after quickening, are said 
to denote the death of the child ; but this is very equivo- 
cal, as many women have produced healthy children, when, 
from these symptoms, they were supposed dead for some 
time. In all cases the woman is not to act carelessly, as 
she may be mistaken, and as the delivery will be always 
easier and safer when left to nature, than when hurried. 

" A discharge of blood from the womb, although a very 
frequent, and generally the most important symptom, is 
not always followed by miscarriage ;" as you will find, by 
reference to what was said on floodings. 

Doctor Burns observes, " when abortion is going t& 
take place, the patient feels pain in the back and lower 
part of the belly, with uneasiness like colic, and a sensa- 
tion of slackness. This state, if not preceded, is soon 
followed by a discharge of blood, and presently regular 
bearing down pains are excited. The discharge is some- 
times from the commencement red and profuse ; but in 
other cases it is at first rather watery, or sparing in quan- 
tity ; presently it flows more copiously, and considerable 
clots come away, often pieces of skinny or fleshy looking 
substance may be discovered. In some cases there is 
much pain and little discharge, or the reverse may hap- 
pen, or both may be considerable and protracted. If the 
miscarriage takes place at a very early period, little caa 
be detected except clotted blood, but if every thing be put 



137 

in a basin of water, sometimes a more solid substance may 
be observed, like a chesnut, which, when examined, con- 
tains a small bag of water with a child in it, no larger than 
a bee. If the third month be completed, we find that the 
whole conception comes away at once, like* a bag covered 
with fringed vessels ; or, if the bag burst before it comes 
away, a gush of water takes place ; by and by the child is 
expelled, and some time after the after-birth comes away. 
Abortion is sometimes preceded by shivering, attended 
with great pains and a feeling of sickness or sinking about 
the stomach, or a tendency to faint ; occasionally the pa- 
tient is greatly troubled with wind in the stomach or bow- 
els. But the symptoms vary in each case, as does the du- 
ration. In some the whole process is over in six hours, 
in others it is protracted for many days." 

The treatment of females during a miscarriage is clear 
and simple. On the least attack, or symptoms of its ap- 
proach, they should go to bed, with a resolve not to rise 
until the event is decided. If of a full habit, they should 
be blooded. They must be kept cool and quiet, avoiding 
every thing heating, drinking only cold water, or some 
weak tea. The bowels may be opened by injecting warm 
water. Sitting in a tub of warm water will always lessen 
the irritation of the womb. 

The application of large quantities of sweet oil around 
the back, belly, and breasts, will also have a considerable 
effect in allaying the action. 

When the expulsion has actually commenced, it is im- 
possible to prevent the completion. The woman should 



133 

keep quiet, as in common labour* A cold, wet rag to the 
belly will promote the contraction of the womb. Some- 
times the contents of the womb (called ovum) lodge either 
at its neck or in the birth-place, when it is proper to intro- 
duce the finger,* and move it from side to side, for hurrying 
its expulsion. 

The after-treatment, particularly in full habits of body, 
is, to evacuate freely by bleeding and purging, with salts, 
cream of tartar, and oil. From neglect to do this, inflam- 
mations have come on, ending in lamentable derangement 
of these parts; as cancers, dropsies, and barrenness. The 
treatment which cures the tendency of the system to abor- 
tions, is not so very certain of success. Before pregnancy, 
bleed, live low, to take regular, gentle exercise, to avoid 
violence and excesses, to salivate, and to change the gene- 
ral habits of the body, as well as residence, are the general 
prescriptions which have done good. 

The course I would prescribe is, to revolutionize every 
habit, to eat a different diet, particularly using sweet oil, 
to take a new exercise ; to arouse the system every morn- 
ing by the shower bath of salt water, to apply the flesh- 
brush to the skin every night. When conception has tak- 
en place, the most gentle exercise, regularity in eating 
simple food, and evacuating the bowels, daily applying 
sweet oil round the back and belly ; to keep the birth- 
place free from all irritating matters, by nightly washing 
in warm water ; to bleed on the slightest feel of fever or 
fulness ; and to preserve the breasts in a state free from 
irritation, by applying sweet oil to them, and keeping them 
unconfined. Above all, I would the most earnestly re- 



139 

commend, as the most certain cure, to have the breasts 
drawn, particularly alter an abortion. When the abortion 
has taken place, a child or grown person may suck the 
breasts, and milk will be secreted. This secretion of milk 
should be kept up for six or eight months. In one in- 
stance, in my neighbourhood, a child was taken by a lady 
who was subject to, and then had an abortion, and she raised 
it in good health. After a few months, the lady became 
pregnant, and, to her great joy, passed, for the first time, 
to her full time for delivery. This is, unquestionably, the 
most certain mode of enabling a woman to pass to her 
full time, which has yet been discovered. 

BARRENNESS. 

Inability to conceive, is a misfortune distressing many 
women, as much as habitual abortion. It is often fol- 
lowed by constitutional affections, of fatal tendencies. The 
cure has been sought after with great earnestness. 

In some instances barrenness proceeds from defective 
organization. These cases are, however, very rare, and 
cannot be cured by art. The next general cause is a tor- 
por, and irregular action in the womb and its appendages, 
which often yields to judicious management. 

The general means of relieving this misfortune which 
have been prescribed are, to revolutionize the system, to 
travel, to excite action on the surface by the salt bath, to 
vary the exercise and habits as much as possible ; and in 
some instances, salivation has been resorted to with good 
success. 



140 

Viewing the subject of the propagation of our species 
in an important light, I early gave it considerable attention. 
The theories published on this subject, appeared too defec- 
tive to be satisfactory. The result of my investigation, as 
will appear from reference to the medical repository, was, 
that the presence of a pure vital air was necessary for suc- 
cessful copulation, or the first excitement of animal life ; 
that in a foul impure air, impregnation could not take place. 
These inferences appeared the more correct, as those who 
cohabit like the negroes, in open fields, at the sides of hills, 
seldom fail in impregnation. All the animals of creation 
require a similar pure air. It follows of course, that the 
connection in the foul air of beds, which will often extin- 
guish a candle, is improper : that persons solicitous of suc- 
cess in the business, ought always to get into fresh pure 
air : that, for a like reason, when the birth-place secretes 
freely, it should be Well wiped, as the secretion might ab- 
sorb the pure air. 

But the great, the important means of rousing the womb 
to action, will be found by exciting the breasts to their na- 
tural action. The connection between the womb and 
breasts, has been before remarked ; it is scarcely possible 
to excite an action in the one, without affecting the other. 

The most natural action for the breasts is the secretion 
of milk. They have often been excited to the discharge, 
without pregnancy. A child losing its mother, and sleep- 
ing with a female friend, has been known in the night, to 
get the nipple in the mouth, and to excite milk by the 
morning : the discovery led to the resort, and the child 
was abundantly nourished at the breast of the maid. 



Ill 

There can be no question that any female breast may be 
excited to the secretion of milk. The means are simple. 
The woman should drink freely of any liquid, and live 
freely. The breasts should be handled frequently, rubbed 
with the softest hand, bathed in sweet oil, and a warm 
poultice applied over the whole of them for an hour. Then 
it should be removed, and the breasts still be handled and 
sucked gently, at repeated intervals throughout the day, 
for several minutes. Particularly every morning, noon, 
and night, the operation should be renewed until the se- 
cretion comes. A young dog has often been used for draw- 
ing the breasts. When the action is excited, it should be 
kept up for months, by daily sucking them : about the time 
of discontinuance, and sometime after, impregnation may 
most probably be effected. There can be no doubt of the 
womb's being more acted upon, more roused to natural 
action by these means, than by any other we know. 

I have recommended the excitement of this secretion, 
as will appear from reference, to those labouring under 
suppressed or profuse menstruation ; also to relieve the 
womb from habitual miscarriages. I will now only add, 
that as milk is the most delicious food taken by children, 
that the ladies declining marriage, might render an essential 
and honourable service in raising the human family. Let 
them excite their breasts to the secretion of milk, and 
they will have the joy of gratifying many poor infants 
pining away for natural food, and many poor mothers, too 
reduced to afford sufficient nourishment. The consequent 
exemption from spleen, and the pleasure of contributing 
to the growth of some friend's, some sisteris child, will 

T 



cause a revolution in public sentiment, a general declara^ 
tion, that the old maids are as valuable, as estimable as the 
young ; which I sincerely pray God may be the fortunate 
issue. 



143 



LETTER VII. 



-Bistort/ of natural labour — offices of the attendant, or mid- 
wife, in such cases — recapitulation — Questions, and an- 
swers in illustration* 

The subject to which I have now to request your at- 
tention is extremely interesting ; one of the most natural 
operations to which your systems are liable. I mean the 
delivery of the contents of the womb, by what is com- 
monly called labour. Should the person have been pro- 
perly occupied, the process will give but inconsiderable 
pain. In the hot countries, among the negroes, and among 
the savages, bringing forth takes but very little time, and 
is attended with most inconsiderable suffering* It does 
not there seem to be verified, that " in sorrow shalt thou 
bring forth," but only where the rules or laws of nature 
are disregarded. 

Indeed, considering the extraordinary facilities nature 
has provided for the birth ot the human kind ; consider- 
ing the numbers who bring forth daily without suffering, 
it seems wonderful how so many ladies, on such occasions ? 
can make such a to do about the business, can so idly in- 
jure themselves with unhappy conceits, can apprehend any 
thing but the most fortunate termination of their case. 



141 

But the cause of all such groundless fears may be traced 
to the arts and ignorance of designing persons. A thou- 
sand times more notice is taken of one little irregularity 
of the attendants, than of the many cases nature conducts, 
without aid. This operates on the fears of the women ; 
each considers the worst may be her case ; assistants 
at extravagant rates are sent for ; and they pocket, 
commonly very handsomely, for the folly of the pa- 
tient. 

I beseech you, for the sake of decency, of justice to 
your attendants, of charity to poor women, abandon such 
improper infatuation ; believe the truth, when you are in 
labour, that five thousand chances to one, you will do per- 
fectly well without any assistance ; that in ten thousand 
instances, to one to the contrary, the most common wo- 
men can render you all proper assistance, without the 
meddling of men operators. Their huge fists, zeal for 
hurry, and spirit for acting, have certainly done more 
harm than the improper conduct of women, of which they 
are so fond of talking. This, Dr. Denman, Dr. Buchan, 
and every really great physician, have observed. 

But you are to thank neither man or woman for your 
labours ; nature does the whole business for you, and 
would probably for ever do it perfectly, if you would 
merely preserve sense enough to let her operate without 
your fears, or the meddling of others* 

What is the operation ? By the contraction of your low- 
er bowels, and the pressure produced by the exertions of 
the muscles connected with the parts, their contents are 



145 

expelled ; which, when hardened and done rapidly, has 
often torn the parts. So, by the contraction of the womb, 
and the muscles connected, its contents are squeezed down- 
wards ; and by over acting, improper exertion, come out 
so fast as to tear the surrounding parts. The great secret 
to be pressed on your minds in the very beginning of th'rs 
subject, is, do nothing, leave nature to herself, allow only 
the involuntary powers to operate j and the discharge will 
be productive of as little injury in the case of the womb, 
as in the case of the bowels. Merely to receive what na- 
ture gives up, is nearly as much the duty of attendants in 
the one case, as in the other. 

In manufacturing countries, where men are enfeebled, 
and female children are confined till disease deforms their 
bones, surgical assistance becomes necessary in about one 
case in a thousand. It is only the services of physicians, 
(not midwives) which are more frequently wanted. But 
in other countries, where such evils do not exist, it is most 
preposterous to follow the custom emanating from such 
misfortunes. 

If I can impress it on your minds, that the operation of 
child-bearing is most simple ; that it is performed by your 
own systems, not by attendants' hands ; that the pains of it 
are to be lessened by leading a proper life of industry, in 
pure air, and cleanliness and temperance ; that you wilt 
seldom require the least assistance from any but your own 
sex, cautioned not to interfere with you ; that when you 
do want other assistance, in almost every instance a good 
physician's prescriptions will afford you relief, with a wo- 
man's hands to operate, I shall have effected a great deaL 



146 

For by this, there will be an abatement of your fears, which 
will greatly abate the pains and dangers of your body, so 
greatly increased by your incessant fears and forebodings, 
before and at labour. 

The natural history of labour, and the offices to be per- 
formed by attendants, are as follows ; 

There are slight and flying pains over the belly, the 
womb appears to contract, or, as the widwives say, it falls 
down, or descends lower in the belly, sometimes even for 
some days previous. Gradually these pains increase, and 
the intermission between them becomes less. The pains 
are produced unquestionably by the contraction of the 
fibres of the womb, and differ in severity according to the 
peculiarity of the person ; in some being so slight, the child 
has been evacuated in the necessary, without a knowledge 
of the birth. Many other parts of the body become pain- 
ed, in consequence of their sympathy with the womb. Ge- 
nerally in a few hours, sometimes in less than an hour, the 
business is completed ; of the rapidity of which, some idea 
may be formed by the rapidity of the pains or contrac- 
tions. 

The following excellent account is from Dr. Denman, 
" About the commencement of the opening of the mouth 
of the womb, by the pushing forward of its contents, the 
anxiety of the woman appears to be greatest ; her manner 
excites great sympathy, and it is necessary the attendants 
should console her, and do nothing, whatever may be the 
entreaty of herself or friends. In the beginning of labour, 
there is frequently one or more chills, called rigors, with 



147 

or without a sense of cold in parts of the body, which being 
void of danger, and showing that the whole system is occu- 
pied in the business, ought not to be alarming. There is 
frequently an inclination to avoid urine, sometimes an in- 
ability to retain it, sometimes an inability to retain the ex- 
crement, and a constant discharge of it, which is to be in- 
dulged in the beginning, aided by a clyster of warm water, 
if convenient ; care being taken not to sit down low for the 
evacuation, lest the child should be thrust out. If the 
evacuation can be had lying down, it is always best. There 
is a colourless mucus discharged from the birth-place, which 
is sometimes tinged with blood, and is called a shew. 

" The pains of labour return periodically ; the intervals 
between them being of different continuance. In the be- 
ginning, they are slight in degree, and have long intervals ; 
but, as the labour advances, they become more violent, 
and the intervals shorter. Sometimes the pains are alter- 
nately strong and weak, or two weak, then one strong ; 
and there is reason to think, that every variety has its ad- 
vantage, by being suited to each patient. In every circum- 
stance," continues the doctor, u which relates to natural 
labour, it is impossible not to see, and not to admire the 
wisdom and goodness of Providence, in making the pow- 
er, and fitting the exercise, with a marked regard to the 
safety of both mother and child. This should afford a les- 
son of patience to those females who become intractable, 
losing their self-possession, add to the evils of their situa- 
tion, as well as to those practitioners, who, being led away 
by popular errors, attempt to add to the strength of the 
pains, or to quicken their returns ; acting as if they 
thought there was no other evil to be dreaded but a slow 



14S 

labour; WHICH HAS DONE MORE MISCHIEF 
THAN THE MOST SKILFUL PRACTICE HAS 
DONE GOOD. 

Although there be some repetition, I give the following 
from Dr. Burns, to impress the more on your minds the 
general history of labour. 

" The first stage of labour is preceded or accompanied 
by a subsidence of the belly ; and the child is often felt, 
even for some days, to be carried lower than formerly. 
The pains at first are short, and come seldom. They go 
entirely off during regular intervals ; but they often leave 
a considerable degree of general uneasiness, so that the 
woman feels restless and uncomfortable, or is hot and cold 
by times ; and in some cases has a sensation of sickness, 
or gripes, or a troublesome desire to make water. The 
pains are usually felt chiefly in the back ; but in some 
cases they often skip to the fore part of the belly, or are 
from the first felt there. They are at first very slight, and 
but only for a short time, perhaps not half a minute, and 
return at the interval of fully half an hour ; but they come 
on with more frequency as the labour continues, and are 
felt lower down in the back, short around to the top of the 
thighs, and cramps are also occasionally felt in the legs. 
They are also attended w T ith an inclination to catch at, or 
take hold of the chair, or of any thing which is near. 

" The pains, after a short time, gradually increase in 
sharpness and frequency; they often seem to decline for a 
time, after which they again become brisker. There is a 
great diversity in the situation and degree of the pain, for 
in some cases it is felt chiefly in the belly, in others in the 



149 

back ; sometimes it is attended with shivering and trem- 
bling, in other cases with sickness and vomiting. These 
circumstances, though unpleasant to the patient, are by no 
means unfavourable, but, on the contrary, often called a 
quick labour. 

" This stage is attended with a discharge of slimy fluid, 
which, when the orifice of the womb is considerably open- 
ed, becomes of a red colour. These pains are often sharp, 
and seem to be doing no good, and the woman is apt to 
become restless and fretful ; and as they are sometimes at- 
tended with sickness, heart-burn, and vomiting, she be- 
comes impatient and depressed in her spirits. 

" These pains proceed from the attempt made by na- 
ture to dilate the mouth of the womb, and they must con- 
tinue till this be accomplished. The complete dilatation 
is assisted and rendered both easier, and frequently more 
speedy, by the protrusion, through the mouth of the womb 
into the vagina, of part of the bag which contains the 
child, and the water which envelops it. The degree to 
which it is pushed out of the womb, during a pain, varies 
much in different cures. Sometimes, it forms a very 
slight projection ; at others it is very bulky, as large as a 
child's head ; when these membranes begin to be pushed 
down, the water is said to " gather." 

" The mouth of the womb being considerably opened 
by these operations, efforts are next made by the system 
to press down the child, to empty the womb. These pro- 
duce a change in the pains, which are attended with the 
inclination to press down. This gradually increases, and 

u 



150 

at last the sensation of bearing down becomes very strong, 
almost irresistible ; and it is observed, that though the 
pains be strong and forcing, they produce less complaint, 
than those which in the beginning of labour appeared to 
be less severe. There is a great variety in the duration of 
this part of the process. It is sometimes gradual and 
slow ; in other cases sudden and rapid. The pains may 
be strong and forcing, have very little interruption, may 
come on at regular periods, with complete intervals ot 



During this period, the bag, or membranes holding the 
waters, in which the child lies, usually bursts, and the li- 
quor contained is discharged, at least the greater part. 
This event is soon followed by an increase of the pains, 
which become more forcing, and the spirits of the woman 
rise in proportion. At length the head of the child ad- 
vances to the birth-place ; (refer to figure the ninth ;) some- 
times it seems to draw back ; again it advances and dis- 
tends the external parts gradually and repeatedly ; this 
being designed for their dilatation. The parts dilating, the 
head at length passing, gives a momentary relief to the 
woman. In a few minutes the pains return, the body of 
the child is expelled, it begins to cry as the air penetrates 
its lungs ; the woman appears, from the release of pain, 
and the pleasure of being a mother, to have the happiest 
feelings. 

In a few minutes after, differing in each case, the womb 
continuing to contract, the pains are felt, and the fleshy- 
substance, called the after birth, or placenta, or secundines, 
with the membranous bag which contained the whole, and 



151 

clots of coagulated blood, are all expelled by a similar 
operation ; the pains being half as severe as those attend- 
ing the expulsion of the head. 

" The duration of this process is various, but it is ge- 
nerally longer in the first child than afterwards. This is 
particularly the case in the second stage of labour, when 
the external parts being rigid, not having been dilated, 
most remarkable in those marrying late, the passage of the 
head is delayed. Some women are always expeditious, 
others tedious in the operation. Some have the waters 
discharged early, others not till the child is born. Some 
have much sickness, as retching, shaking, others none at 
all. In short, there is a great variety in these respects 
with different women, or with the same woman in differ- 
ent labours. In a natural labour, the whole process is con- 
cluded within twenty-four hours j oftentimes in a much 
shorter period." 

With this description of natural births, I proceed to 
speak of the duties the attendant has to perform. In ge- 
neral, one assistant is enough, two are a great abundance, 
and more than three persons should never be allowed to 
enter the room. I shall suppose that no midwife can be 
had at the time, or if an ignorant one, that some lady of 
sense enough to understand the most simple things, will 
stand by and direct. But admitting a midwife of great 
conceit, or of great reputation, attend, the directions are to 
be attended to ; and the friend of the woman in labour 
should stand by, and not suffer the dictates of experience 
and common sense to be sacrificed to notions of dexterity 
and successful performance, which have slain their thou- 
sands and tens of thousands. 



lf>2 

The first business is to sooth the woman, to compose her 
mind as much as possible. All other animals, and women 
in a state of nature, retire to some sequestered spot to bring 
forth. There should be but little talking, that little for 
consolation, and recommending patience, never for the en- 
tertainment of the by-standers, as is generally the case. 
The largest room should be taken for the operation ; the 
bed neither exposed to a current of air, or the heat of a 
fire. Free airing is very important from the beginning 
to the end ; nothing being more prejudicial than a con- 
fined atmosphere, for mother and child. 

The moment a woman conceives herself in labour, she 
ought to be dressed in the loosest clothes, of the kind that 
may be most easily removed ; then to have every thing 
that may be wanted for herself or infant ready in the 
room. 

Instead of the parade that is made about getting the bed 
ready, all that is necessary, is a bed made up as others, 
with, on the part her middle is to rest, several separate 
cloths, that the top one may be pulled away from under 
her, as it becomes dirty, leaving the next one for the up- 
per piece ; and so on till all are taken away. 

The articles required in the room, after baby cloths, are 
cold water for drinking, and for a bath if accident occur ; 
any weak tea, or gruel, in case of its being desired ; then a 
clyster pipe ; warm water and soap to be in constant readi- 
ness ; a pair of scissors and a little cord of tape, or any 
string, to tie the navel with ; old cloths for wiping up what- 
ever may be offensive to cleanliness, or to the sight. 



153 

The first thing required of an attendant to a woman sup- 
posed to be in labour, is to ascertain if the labour has ac- 
tually commenced, an operation called TOUCHING. 
This is done by introducing the fore-finger up the birth- 
place, to feel if the mouth of the womb be opening. The 
fore-finger is introduced near the pubes, and then pushed 
backwards as a pain is coming on. If the orifice of the 
womb appears to dilate during the pain, the woman is cer- 
tainly in labour ; and this is the only certain proof of its 
existence. 

The best position for touching is when the woman is 
standing, leaning on the shoulder of the one feeling. It 
may be well done while she is lying on her side. It should 
always be done with the greatest gentleness, as from vio- 
lence the bag of waters have often been bursted, to the 
great injury of the case. In general, no oil or grease is 
necessary for the operation, (as formerly used,) since the 
natural secretions are unquestionably the best for lubrica- 
tion. The finger being introduced, it should be held still 
until a pain is commencing, when the mouth of the womb 
will be felt opening. This dilatation of the mouth of the 
womb being ascertained, np more inspection should be 
made for some time, as frequent examinations do no good, 
and much irritate and inflame the parts. 

When the pains have frequently recurred, always, if there 
has been an evacuation of the waters from the womb, the 
woman should be touched again ; sometimes the hard head 
of the child may be felt, resting against the front bones : 
if the waters have been evacuated, the hairy scalp of the 
child, sometimes in parts, folded as a cord, the openings 



154 

called the suture-;, kmd the back fontanelle, sometimes the 
pulsation of an artery, may be felt. In every inspection, 
again and again, the attendant should feel most gently. 

In addition to the dilatation of the mouth of the womb, 
the existence of true labour may generally be predicted, 
from the " recurrence of the pains at regular intervals, by 
affecting the back, and shooting around to the thighs, and 
by protruding the bag, as a bladder of water, through the 
mouth of the womb." 

The actual existence of the labour being established, the 
woman should evacuate her urine and excrement, the last 
by the aid of a clyster of warm water and soap. If the 
urine have not been evacuated for twelve hours, a catheter 
ought to be used for the purpose, unless sitting in a tub of 
warm water, or an evacuation from the bowels, produce 
the discharge. I repeat, have the bowels well opened with 
an injection, because the confined excrement obstructs the 
passage of the child's head, and causes the parts of the mo- 
ther to be destroyed by the compression ; because, unless 
this be done, there is an evacuation at birth, so offensive 
as often to interrupt the operations of the attendants ; and 
because it proves of great service to the woman after la- 
bour. Indeed, ladies, you will save yourselves a world of 
suffering, if you will attend to the injunction of emptying 
your bladder and bowels on the approach of a delivery. 

The directions for a woman to observe when labour has 
commenced, are various ; but those most consistent with 
common sense are the best. Dr. Burns says, that " in the 
first stage of labour the patient may stand, walk, or sit, or 



153 

* 
remain in bed, as she is inclined ; but by no means stand 
as long, or walk so much, by way of forwarding the la- 
bour, as is productive of fatigue. Women should always 
be impressed, that a slozv labour is much less injurious than 
those which are quick. When the pains become frequent 
and pressing, she should keep to her bed. 

" Before the child is delivered, there is often a strong- 
desire to rise to go to stool, but is not to be indulged, as 
the child might, with great danger, be born when the wo- 
man rises up. Sometimes it has been born in the pot ! 

a Fretting should be avoided as much as possible. All 
voluntary attempts to press down, called bearing down, 
must — must be avoided, as by expediting the passage of 
the head before the dilatation is effected, the parts might 
be miserably torn." 

After the head of the child descends in the birth-place, 
the external parts begin to obtrude, and great attention is 
necessary, not to do, but to guard against doing too much. 
An account of all ills brought on by interfering in this 
stage, would appear incredible. All parties seem, in this 
stage, to unite in doing the wrong of hurrying the birth. 
The woman should be confined to her bed. The best po- 
sition for all parties, is lying on her side, legs drawn near 
the belly, and a pillow between the thighs. Talk to her, 
to prevent her bearing down. Keep the hand applied be- 
tween the fundament and birth-place, (part called perine- 
um.) The pains in this stage of labour, are called bearing 
or forcing pains ; as the woman, by her exertion, bearing- 
down, forces, most improperly, the delivery. As the head 



15(3 

advances, push your hand with a force equal to about 
pushing forwards a ten pound weight. If the head be 
coming too rapidly, extend your hand, so as to delay its 
passage, for a pain or two pains more ; tell the woman not 
to bear down ; and still as the child's head passes, keep the 
hand pressing against this perineum, so as to incline the 
child's head forwards, towards the pubes. The head hav- 
ing passed, the perineum retracts, a respite is felt. The 
body of the child is not then to be touched, the pains of the 
mother will soon expel it ; they alone are to do it. The 
hand is to be kept on the perineum, as the shoulders and 
hips pass, pressing as before, though with less force. 

The child being thus born by the powers of the mother, 
it is to be left, its head free for fresh air, during its crying ; 
it is not to be touched for some time. When the navel 
cord begins to lessen its pulsation, always remain from 
eight to twenty minutes, the cord is to be tied within two 
or three inches of the child's navel, by any kind of string, 
moderately tight; then tie it again, two or four inches 
from the last knot, towards the mother, in like manner; 
the cord between the knots to be cut in two with a knife or 
scissors ; always look while doing this, lest some parts 
may be cut, which should not be, as has been done. 

The child being handed over to be washed in warm wa- 
ter, and to be dressed in the most free, loose, easy, possible 
manner, the woman is to remain quiet. The after-birth, 
placenta, and membranes, are to come away, and soon the 
womb contracts, the pains return, and the whole is expel- 
led. If it be detained longer than thirty minutes, the belly 
is to be rubbed, the woman may roll over in bed to the 



15? 

other side, the cord may be pulled a little during a pain, 
with a force equal to one pound. Some robust persons 
have been advised with success to stand up a minute or 
two j these means not succeeding, a cold wet rag applied 
to the belly will excite the action j lastly, the finger may 
be pushed up the birth-place, and being turned around the 
sides of the womb, excites it to contraction. Remember, 
the object is not to drag away the after-birth, but it is to 
cause the womb to contract, to expel it. If there be much 
loss of blood, cold water to the belly, by means of wet 
rags, and pushed a little way up the birth-place, will stop 
it ; fainting is to be encouraged, not hindered, as during 
fainting the bleeding is checked. 

The after-birth being discharged by the contracting 
power of the womb, the woman is still to be kept reclin- 
ing ; and being wiped dry, is to be rolled over to the 
dry and other side of the bed ; turning over is best ; she 
may be lifted as she lies, but should not elevate herself. 
Any succession of cloths may be pushed under her; and 
between her thighs, at the birth-place, a rag is to be applied, 
to absorb the d ischarge that follows. 

Thus, you must be struck with what inconsiderable of- 
fices are to be performed by midwives. A great duty 
is, to know when not to act, which very few have 
learnt properly. In 999 cases out of the thousand, in this 
country, excepting when a physician is wanted to prescribe 
for the constitution, they may be summed as follows, and 
ought to be committed to memory by every female. 

" To have the woman's urine and excrement well eva- 
x 



158 

cuated in the beginning; to keep her composed and quiet ; 
charging not to exert her voluntary powers, as the work is 
best done by the involuntary ; to be careful not to burst 
the bag containing the waters, by fingering ; nor to be too 
constantly fingering the parts. When nearly ready for 
delivery, to keep her lying on her side : knees drawn up- 
wards, and opened by a pillow between them. As the 
child's head advances, and distends the parts about the 
fundament, to keep the palm of the hand ready to press 
as the head protrudes, pressing equally and gently on the 
perineum, so as to incline the head forwards, towards the 
front or pubes ; and when, as the child appears to be ad- 
vancing very rapidly, threatening to pass before the parts 
are opened, to incline the hand more forwards, so as to de- 
lay its passage for a pain or two ; in this stage particularly, 
entreating the woman to be quiet ; to let the child's body 
be expelled by the powers of the mother ; of the cord, be 
sure that it is not compressed or tightened, and in ten or 
twenty minutes, when its pulse ceases, tie it in two places, 
two or three inches from the navel, then towards the mo- 
ther, and cut it between the knots ; to wait for the af- 
ter-birth ; if it do not come away in thirty or fifty minutes, 
to roll the woman on her belly and back again ; to rub the 
belly with the hand, and to pull the cord with a force not 
exceeding one pound weight, to excite the womb to con- 
traction ; lastly, in an hour, applying for a minute, a cold 
wet rag to the belly, another to the birth-place, and always 
doing this when there appears to be a great loss of blood. 
The woman to be rolled over, wiped dry, and put in her 
place for repose." Duties which can be done by the low- 
est servants, and not disgraceful, if performed by the high- 
est, to a suffering mother. 



li>9 

If these offices be compared with those generally per- 
formed by common attendants, a great difference will be 
found. True, persons frequently do very well, under the 
different and great varieties of treatment. But it only 
shows that women have wonderful constitutions, and can 
stand against incredible exposures, and ill treatment. 

I will now make a few questions and give their 
answers, the more effectually to impress on ladies' minds 
the offices to be performed at labour. 

Q. What is the first thing a woman in labour should 
attend to ? A, The evacuation of the bladder and bowels, 
in order to prevent the compression and injury of these 
parts. 

^. What ought the attendant first to do ? A. Introduce 
the finger up the birth-place, and gently, during a pain, feel 
the opening of the mouth of the womb, in order to pro- 
nounce certainly whether th£ labour exists. 

$%. What will she feel on introducing her finger ? A. 
Probably the bag of waters, like a bladder, which she 
is to touch so gently as not to endanger bursting ; if the 
labour has not advanced, she only feels the mouth of the 
womb gradually dilating at each pain. 

i^. W 7 hen the waters are discharged, what should the 
attendant do ? A. Examine or touch the woman again, so 
as to feel what part of the child presents at the mouth of 
the womb. 



160 

i^. Finding the hard bones of the head, probably the 
hairy scalp, folds of the scalp, and observing, probably, 
the pulsation, of some artery of the head ; what should be 
done ? A* Nothing, but keep the woman in bed, her legs 
drawn up, a pillow between her thighs, so as to give room 
for the passage of the child, and to allow its head to rest 
on delivery. 

i^. What is the difference between the pains when the 
mouth of the womb and external parts are dilating ? A. 
When the mouth of the'womb dilates, the woman feels 
more excruciating pains, called grinding, rending, and 
cutting pains. When the external parts dilate, she feels 
bearing, forcing pains, as if the external parts were 
bursting. 

^. What are you to do, when the last pains come on ? A* 
Keep the woman in bed, the right hand against the part 
called perineum, between the fundament and birth-place ; 
earnestly entreat the woman not to bear down ; to amuse 
herself with talking ; lastly, as the head advances, press 
firmly against the perineum, so as a little to incline the 
child's head towards the front or pubes, in order to sup- 
port this perineum. 

i^. What is the difference between the perineum in this 
stage, and when not distended ? A. In a common state, 
it is about an inch wide ; at the passage of the child, it 
expands greatly, and becomes very thin, so thin, that by 
hurrying the passage of the child's head, it has been torn, 
leaving the lower gut and birth-place as one opening. 



161 

$. How is this to be avoided ? A. By not hurrying the 
labour ; by holding the hand against it, so as to support 
it ; by resisting, with the same hand, the passage of the 
child's head, for one or two pains, if it appear to be com- 
ing very fast. 

^. When the child's head is expelled, what are you to 
do ? A. Let the head lay supported at the side, and do 
nothing until the pains of the mother expel the body ; 
during the expulsion of which, the hand is to be still kept 
supporting the perineum. 

^. After the expulsion of the child, what is to be done ? 
A> Remain quiet, after allowing fresh air for it to breathe, 
until the pulsation of the navel cord has lessened, and the 
child freely breathes. This is generally sufficient in ten 
minutes, and then, with any string, the cord is to be tied 
near the navel, within a short distance, and cut between 
the knots. 

^. After the separation of the child, what is next to be 
done ? A, Let the woman remain quiet for a few minutes, 
then feel her womb through her belly, to see if it is con- 
tracting, to expel the after-birth. If it do not contract, the 
belly is to be gently rubbed, and the navel cord a very lit- 
tle moved, to excite the womb to contraction. 

^. Are you in any case to pull the after-birth away by 
the navel cord ? A. By no means ; as the object is not to 
take it away ; but to make the womb discharge it by its 
contractions. 



162 

i^. What other means are there for exciting the womb 
to expel the placenta ? A. Turning the woman over 
on her belly ; then introducing the finger to the mouth of 
the womb, and turning it around its edge, to excite its ac- 
tion ; at the same time gently extending the cord, so as to 
aid in producing the contraction. In strong women, who 
have not lost blood, they may stand up, leaning the head 
and body over the operator : lastly, if the after-birth do 
not come away in one hour, the hand may be introduced in 
the birth-place, and the fingers extended all around the 
edge of the womb, to make it contract ; and then insinuated 
between the edges of the after-birth and womb, slowly se- 
parating them, if they adhere, as the contraction goes on. 

S%. If there should be an alarming discharge of blood, 
how would you stop it ? A. By applying a cold, wet rag 
on the belly, and pushing another a little up the birth-place. 

i^. What are the evils of pulling away the after-birth ? 
A. The separation being made before the contraction of 
the blood-vessels, profuse bleeding ensues ; and if the ad* 
herence be great, the womb may be torn from its connec- 
tions. 

^. The after-birth being removed, what next? A. The 
woman is to be wiped dry, turned or rolled over to the 
other side of the bed, with a dry cloth at the birth-place ; 
and with fresh air, without a current, is to be left to slum- 
ber quietly for a few hours. 

Recapitulation of natural labour from Dr. Meriman. 
Labour is divided into four stages. 



1G3 

First stage, the head of the child passes through the 
upper brim of the pelvis, and the mouth of the womb di- 
lates the size of a crown. 

Second stage produces that change in the position of the 
head, which turns the forehead into the hollow of the back 
bone, (os sacrum,) and brings the crown of the head to 
emerge under the pubes in front. 

Third stage produces the expulsion of the child from the 
external parts. 

Fourth stage, the after-birth is delivered. 

(Note.) The mouth of the womb opens fully, sometimes 
in the first stage, at others not till the second stage is over. 
The time at which the membranes rupture is various. 
The longer they remain entire, the safer in general is the 
labour : the most natural being when the waters are not 
evacuated, till the head of the child is just ready to pass 
into the world. 

Beginning symptoms of labour, 

First : general and equal subsidence of the womb and 
belly ; a very favourable symptom. 

Second : a discharge of a mucus fluid from the birth- 
place, called a shew, when tinged with blood. 

Third : frequent gripes, and desire to evacuate the 
bowels. 

Fourth : a frequent urgency to make water. 



164 

Occurrences during labour* 

Pains, restlessness, despondency, rigors, vomitings, pro- 
fuse perspiration. 

Pains are true or spurious. The spurious are known by 
irregular occurrence, by affecting the belly more than the 
back or sides, and by not opening the mouth of the womb. 
True pains are known by recurring at regular intervals ; 
by affecting the back, and shooting round to the thighs ; by 
producing a perceptible opening of the mouth of the womb 
during each pain 5 and by protruding the bag of waters as 
a bladder, through the mouth of the womb. 

True pains are of two kinds : 1st. grinding, rending, 
cutting, as the mouth of the womb dilates. 2. Bearing, 
or forcing pains, after the womb has opened, and the bag 
of waters, or the head of the child, is forced through the 
mouth of the womb, and the external parts of the mother. 

The restlessness and despondency of women in labour, 
occur in the early stages, during the grinding pains, gene- 
rally relieved when the bearing pains come on. 

Rigors, or thrillings, often occur during the opening of 
the mouth of the womb, and when it is completed ; some- 
times preceding the passage of the head through the ex- 
ternal parts ; and terminate by producing violent cramp in 
the lower extremities. These are favourable indications 
of labour, different from those distinct shivering fits, the 
forerunners of fever, occurring in long, difficult labours. 



165 

Vomiting is also a favourable symptom in labour, at the 
» beginning ; but should create alarm, when it occurs after a 
long continuance of labour, the mouth of the womb open- 
ed, and pains suspended. 

Perspiration is a natural consequence of labour ; but 
artificial perspiration, brought on by heated air, and bed- 
clothes, or heated liquors, is injurious. 

Rules for Management of Natural Labour, 

1. Natural labour requires but litde assistance. The 
dilatation of the soft parts is effected by the pains, assisted 
by the bag of waters ; of course, no attempts to dilate 
must be made by the attendant. 

2. During the first and second stages, the patient may 
sit, stand, kneel, or walk about, as she pleases ; repose oc- 
casionally on a bed or couch, but not too long at a time. 

3. She should be supplied with mild bland nourish- 
ment, if desired, in moderate quantities. Tea, coffee, 
gruel, barley-water, milk and water, lemonade, broths not 
salted, may be allowed ; but beer, wine, spirits in any form 
should be forbidden, as injurious in the early stages of la- 
bour ; and only used in small quantities in the last stage, 
in cases of great exhaustion. 

4. Bladder and bowels, by all means, to be emptied af- 
ter introducing the finger into the birth-place. 

5. Touqhing must be resorted to in order to judge 
of the progress of labour ; not too often repeated, and 
with great care not to break the membranes. 

Y 



166 

6. The spirits of the patient to be kept up by cheerful 
conversation ; not noisy or unpleasant remarks. 

7. About the end of the second stage, the patient is to 
lay down ; legs drawn to the body ; knees opened with a 
pillow ; the attendant to be behind, ready to support the 
part between the fundament and birth-place, as the head 
and body pass, to retard it one or two pains, if too rapidly 
coming. 

8. After the head passes, allow the pains to expel the 
body. 

9. After the child breathes freely, in ten or fifteen mi- 
nutes, tie the navel cord, one or two inches from the belly, 
another within four or five inches, and divide the middle, 
examining as it is done, to prevent cutting improper parts, 

10. The child being born, secondary pains come on to 
expel the after- birth : these, generally in less than twenty 
minutes, expel it in the birth-place, from whence it is ex- 
tracted easily. 

* 

With all these accounts, recapitulations, questions and 
answers, I do not see how it is possible you can fail under- 
standing the subject of natural labour, so as to direct all 
needful assistance. 



167 



LETTER VIII. 



Contents. General remarks — particular charges to at- 
tendants on women in labour, to prevent flooding and la- 
ceration — the treatment — delivery of after-birth when 
retained — twins — breech presentment, feet and knees, 
forehead, face, head and arms — delivered by powers of 
mother — cases where art is necessary — presentments 
of arms, shoulder, back, belly, sides, navel cord, &?c. — ope- 
ration — recapitulation — tedious labours on account of 
the mother — destruction of child — delivery by the lever 
and forceps — after-birth before the mouth of the womb — 
convulsions — means of lessening the pains of all labour. 

On entering into the subject of the more particular treat- 
ment of women at births, I cannot avoid feeling distressed 
at a survey of the afflictions which so many good mothers 
have had to encounter ; probably as justly attributable to 
themselves, as to their ignorant attendants. For what ex- 
cuse can be found for neglecting to procure accurate infor- 
mation of the outlines of the great work of child-bearing, 
the most interesting operation to which they are subject ? 
Had but small portions of those hours lost on cookery, novel 
reading, and pretty exhibitions, been devoted to the exer- 
cise of common sense, about parturition, there would have 
been scarcely an evil to encounter. To think that rational 
beings would consent to expose their lives to the mercy or 
ignorance of attendants, when they could have felt the se- 



168 

curity of certainty, of what treatment was proper, is truly 
most extraordinary. The more does it deserve to be re* 
probated, since the moment the woman is in the situation 
requiring assistance, the ignorance contributes to the alarm; 
the most indifferent prescriptions are seized, more fatal 
than catching at straws ; they embrace the means which 
increase their danger. 

Of the evils which women have had to encounter at 
births, those from ignorance about what is necessary to be 
done, are not an hundredth part so numerous as those from 
acting in such a way, that a child, understanding how a 
child was born, would detect and condemn. The serious 
misfortunes of bursting the external parts, pulling down 
the womb, alarming floodings, and innumerable mutilations 
of children, ought not to be so much ascribed to the igno- 
rant attendant, as the negligent woman and her friends. 
Should a physician offer to relieve a tooth-ache, by cutting 
off a member of your body, the prescription would be in- 
stantly rejected j and yet such a remedy for such a com- 
plaint is not more ridiculous, more at war with common 
sense, than the exercise of those arts, tricks, and follies at 
births, which bring on the above misfortunes. 

From the history of labour, we learn that the object of 
the slow returning pains was the gradual opening of the 
parts, for the passage of the contents of the womb. To 
say nothing of experience, can you fail perceiving that the 
hurry of the operation must tend to burst the parts ? In- 
deed, for a woman to suffer a midwife, without any cause, 
to be thrusting her hand up her womb, tugging at the parts, 
exciting irregular action and irritation j for her to be pre- 



169 

vailed on to bear down, forcing, striving, to discharge the 
child, all show, that she no more exercises her common 
sense than such officious, meddling midwifes. A contra- 
ry treatment, patiently waiting for the involuntary contrac- 
tions to do the business, and when appearing too rapid, 
to press with the hand on the distended parts, then so thin, 
that is, the perineum, so as to support it, (and not to tear 
it open with her fingers, or slip it off, as some have been 
known to do,) is the course pointed out by common sense. 
To guard against this accident, in addition to the above 
means, the mucus should never be removed from the 
parts ; and when dry, they are to be well oiled. 

When the perineum has unfortunately bursted, the parts 
should be well washed, and freed from any thing that can 
keep their edges apart. A clyster should immediately be 
given, if the bowels have not been cleansed before delivery. 
The thighs should be drawn up, the knees kept close toge- 
ther, the parts at perfect rest ; any mild ointment may be 
applied externally. Sometimes these lacerations have thus 
healed up, though often otherwise ; leaving the excrement 
perpetually entering in the birth-place. 

Slight lacerations of the lips of the birth-place some- 
times take place ; and large quantities of blood are effused 
in the part. This is painful, but requires no other treat- 
ment than a soft poultice, and cold washing. 

Pulling down the womb, and floodings in labour, are 
produced by as unnatural treatment, as much in violation 
of common sense, as the bursting of the perineum. Every 
woman would instantly bleed to death, if, on the separa- 



170 

tion of the placenta from the womb, the womb did not 
contract, so as to stop up the mouths of the large vessels 
which carried the blood to the after-birth. I repeat, then, 
the great business is, not to extract the placenta, not to pull 
at it, (sometimes even the cord has been pulled off, in the 
abominable exertion,) not to force it away, as has been so 
generally done, but to excite the womb to contract and ex- 
pel it. The common sense, therefore, of every woman 
should tell her, that this pulling away must either pull 
down the womb, or separate the placenta before the womb 
contracts, and must produce flooding?, and therefore ought 
not to be submitted to. The means of exciting the womb to 
action in common cases have been mentioned. They 
should be continued after a pain, the cord gently pulled 
(again remember, not to pull it away, but to excite the ac- 
tion of the womb ;) lastly, the hand may be introduced up 
the womb, the fingers rubbed against the sides, around the 
edges of the placenta ; lastly, the careful midwife is to in- 
sinuate her finger all around its edge, slowly separating it ; 
and with a cold wet rag on the belly ; rubbing the belly, 
pressing gently, and moving about the great ball or mass 
of the womb, its contraction will be certain. A general 
rule is never to remain more than two hours without 
forcing the delivery by the above means. The hand 
going into the womb, is guided by the navel cord j when 
the whole is !>rought away, it should be so turned, or 
wiped around, as to take up the membranes and clots 
of blood, which may adhere to the sides, and produce af- 
ter-pains. 

Whenever there is an alarming loss of blood after delive- 
ry, cold water is to be applied ; a bag of fine ice or snow 



171 

has been stuffed up the birth-place, and applied to the 
belly, with success. You are unhesitatingly to pour on a 
pitcher of cold water, and inject the coldest iced-water up 
the birth-plac6 with a common syringe. It is needless to 
add, that the patient should have fresh air, no heating 
drinks or cloths ; and is to be wiped dry, and moved as 
little as possible. 

If the womb has been detached from its connections 
above, so as to come out of the birth-place, called inver- 
sion ; ascertained by its descent, and the vacancy in 
the lower belly, the treatment should be immediately pur- 
sued, as recommended in the description of the external 
parts of generation, to which I refer you. 

Next to the charge, that the attendants are not to be 
allowed to do those things which are found to produce la- 
cerations, floodings, falling down and inversion of the 
womb, and that they are to do all that common sense points 
out for prevention ; they should be warned not to feel, or 
finger roughly, the child in the womb. The gentle appli- 
cation of the finger will enable each part to be more easily 
distinguished. Some midwives have been so rough as to 
push out the eyes, and destroy the organs of generation of 
the child, when such parts presented. 

The directions you have now had, relate to about ninety- 
eight cases in the hundred of births, according to accurate 
records kept of deliveries, at various lying-in hospitals. 
If you attend only to this proportion of cases, you will do 
much good indeed. But I would wish you to do more ; I 
would have you to attend to the remaining cases ; to form 



172 

at least, such a knowledge of each varying case, as will 
enable you to understand the treatment, to direct an attend- 
ant, in case of inability to procure a physician to consult 
with. 

But truly, in most of these two cases in the hundred, a 
physician is not necessary ; the powers of the mother, with 
but little art, are often adequate to disburden the womb of 
its contents. 

You have had accounts only of cases where one child is 
in the womb, and the head presents, with its occiput or 
crown, the back fontanelle, with its three edges and three 
sutures, or seams leading to it. On the belief that you 
will comply with my entreaty, not to be so ridiculously 
fanciful as to suppose every varying case will be your own, 
I proceed to state to you, that there are other cases : cases 
of twins ; and of different parts of the body presenting at 
the mouth of the womb, particularly of the breech. I com- 
mence with twins. 

And first, be not alarmed on the discovery of the exist- 
ence of twins. With proper treatment, the mothers do 
very well. The directions to be observed, are the same as 
those given for single births. Dr. Meriman has summed 
up all the useful information, in the following laconic 
manner. 

" It is seldom possible to ascertain that there are twins, 
till after the birth of the first child ; yet, very rarely, it is 
known during the first labour, by the membranes of each 
child being felt at the same time in the birth-place j and 



173 

sometimes different parts of the two children come down 
together. 

11 Each of the twins is commonly smaller than a single 
child, which occasions often the birth to be rapid ; and 
gives the first idea of the twins. At other times, though 
it is evident the child be small, and there is room for it to 
pass ; yet the pains, though frequent, do not propel it, as 
the action is impeded by the child, at the upper part 
of the womb." After the delivery of the first child, 
by feeling the belly, the existence of another child may be 
ascertained. If the womb feel very large, rather than leave 
the woman in uncertainty, it is advised to introduce the 
hand in it, and feel for the child. Generally in twin cases, 
the second child is delivered in an hour after the first, and 
in a position contrary to that of the first ; so that if the 
first present head foremost, the second is a breech or feti 
presentment. 

" The first child being delivered under the management 
prescribed for single cases, the question to be resolved is, 
whether the birth of the second child shall be left to na- 
ture, or terminated by art. 

" It will hardly be denied, that some time ought to be 
allowed to recruit the woman's strength, and to give an op- 
portunity for the second labour to come on spontaneously. 
There are many cases, in which it would be unadvisable 
to wait so long as four hours, without interference. 1st. 
When artificial aid was requisite for the first delivery. 
2d. When the child presents unnaturally. 3d. When fits 



174 

or flooding come on. In either of these cases, the labour 
is to be finished before four hours." 

" The following is an outline of the practice which I have 
been in the habit of adopting. 1st. When both children 
presented naturally, and the labour of the first terminated 
without aid, and without much fatigue to the patient, I 
wait for the secondary pains ; but should these not come 
on in a reasonable time, (four hours,) I introduce my hand, 
and rupture the membranes ; when, commonly, the second 
child passes readily through the pelvis. 2dly. If the first 
labour has been natural, and the second child presents in a 
wrong direction, I have generally deemed it expedient, 
with very little delay, to extract it by the feet. 3dly. If 
the first labour has been unnatural, with but very little de- 
lay, the membranes are to be ruptured ; and whether the 
child should be brought down immediately, and delivered 
by the feet, or not, the attendants must decide. The rules 
applicable to cases of twins, will equally apply to cases 
where there are three or more children." 

After the delivery of twins, greater care is necessary to 
prevent the mother's fainting, than in single births : she 
should not have her head elevated ; and in moving, should 
be rolled over in the bed. It will be more proper to apply 
a bandage, in these cases, to support the belly. The rules 
respecting the delivery of the after-birth in these cases, are 
the same as in other cases. 

BREECH PRESENTMENTS. 

Cases of the child's presenting with its breech foremost, 
are not very uncommon ; occurring, perhaps, rather more 



±75 

frequently than twins. The signs of breech presentment 
are not very certain at the commencement. In general, it 
may be ascertained by the soft flesh, and globular shape of 
the presenting part, by the cleft between the buttocks, by 
the parts of generation, and by the evacuation of the con- 
tents of the child's bowels, called meconium ; which last, 
however, takes place at other presentments. 

The progress of this labour is generally, particularly in 
the beginning, more slow than presentments of the head. 
The thighs and feet of the child are drawn up close to its 
body ; and in its passage through the? pelvis, the navel cord 
being compressed, the death of the child is very apt to oc- 
cur. Delivery in these cases is generally effected by the 
powers of the mother. At first, while the breech remains 
above, nothing but patience is necessary ; when it passes 
out of the external parts, the perineum is to be supported 
with great attention, as it is more apt to burst in these 
eases, particularly as the heels pass, they are very apt 
to produce the laceration. As soon as the navel cord ap- 
pears at the navel, it should be pulled down a little, to les- 
sen the stretching. In this situation, every thing should 
be done to hurry the delivery, which is consistent with her 
safety. The compression on the cord soon causes the 
death of the child, which may be remarked by its convul- 
sive, tremulous motion. The belly should be rubbed, 
gently pressed, to excite pains. As soon as the arms 
appear at their shoulder joint, the finger should be in- 
troduced over the shoulders of the child, as far as to the 
bend of the elbow, and then gently depressed, when the 
fore arm passes readily into the birth-place ; the second arm 
will be more easily extricated. The body of the child is 



17« 

then to be gently extended, in the direction it appears ad- 
vancing : not powerfully, as death will be produced by the 
destruction of the back-bone. When the neck appears, the 
finger may be pushed up around the mouth of the womb, 
apd moved or rubbed a little against the edge or sides of 
the cavity, in order to hurry a return of pains. As soon 
as the mouth can be reached, a finger should be introduced 
in it, ahd the chin pulled down, to expedite the birth, at 
the same tirrje that air may enter its mouth. Strong wo- 
men may stand up, or kneel, in these cases, to hurry the 
delivery. 

In some cases, the child presents with its breech situat- 
ed differently from the above ; so that the face is towards 
the pubes, and as the chin may lodge against them, and 
retard the labour, the attendant should turn the belly of the 
child to the best direction. When the breech is delivered, 
and the toes are towards either hip of the mother, the child 
is in a right direction. But if the toes point to the pubes, 
or belly of the mother, the head will come in an unfavour- 
able position ; and therefore, it will be proper, as soon as 
the breech is delivered sufficiently, to take hold of the 
thighs with the two hands, and when the next pain comes 
on, so to turn the body, or give it such a slight inclination, 
by guiding it with the hands, as will direct the face to- 
wards the mother's spine. 
■ 

" There is no difficulty in effecting this turn, if it be 
done prudently and cautiously. Much force is not re- 
quired ; nor is it necessary that the child's belly be turned 
quite round to the mother's back ; an inclination towards 
the mother's back is all that is wanted. 



177 

In cases where the mother has a large, well-formed pel- 
vis, the child may certainly be delivered living ; but the 
chance is very indifferent, when the pelvis is narrow, or 
any thing occurs to retard delivery. I should recommend, 
when ever a breech presentment can be ascertained to ex- 
ist, to send for some experienced hand ; or, at all events, 
the united sound sense of the bystanders must be exerted 
in defending the perineum of the mother from laceration, 
and the child from death, by delay in the pelvis. To this 
I will add, that the efforts to reanimate the child, by blow- 
ing down its nostrils, rubbing its skin, bathing in hot wa- 
ter, should be continued two hours at least, as life has been 
restored in several cases of longer duration. 

The next presentments of children at birth, are the 
knees, and the feet. Sometimes either one foot, or one 
knee. The knee may be ascertained by its bluntne.ss ; the 
foot by its thickness, the heel, the great toe, shortness of 
the toes, and their forming nearly an even line. 

The treatment in these cases is precisely the same as 
that of breech presentment. If the child do not present 
so that its face shall be towards the back of the mother, 
its body is to be a little inclined towards it, as soon as the 
breech is delivered. The navel cord is to be guarded 
from extension, and the birth, after the navel passes, to be 
hurried as much as possible ; though all these cases are to 
be left to nature, until the navel passes, In these cases, the 
greatest possible care is to be taken not to burst the bag of 
waters, which will hinder the dilatation, so particularly re- 
quisite in such presentments. 

You have now the history of the births upon a fair ave- 



178 

rage of four thousand nine hundred and ninety cases in the 
5000. You perceive the offices to be performed by attend- 
ants, in all these cases, amount to almost nothing ; chiefly to 
not breaking the membranes ; applying the hand to the peri- 
neum, to support it ; and, in possibly one case in a thou- 
sand, inclining the body a little round, so as to turn the 
face towards the back of the mother, when, as so rarely 
happens, the toes are towards the belly of the mother ; 
and lastly, in hurrying the labour, when the navel is de- 
livered, by telling the mother to bear down ; by rubbing 
the belly, and by a gentle pulling of the body in the di- 
rection it advances. 

Although I consider any further detail to you on the 
subject of midwifery, as unnecessary for any useful pur- 
poses ; yet as it may tend to gratify curiosity, and possi- 
bly be a subject of reference by some practising midwife, 
I proceed to state the remainder of the cases occurring. 

It is probable that there is not one part of the infant's 
body which has not, at some time or other, presented at 
the mouth of the womb for delivery. The rules to be 
observed, in such cases, I shall continue to extract from 
Dr. Merriman. 

" The irregular presentations of the head are, when the 
forehead is towards the pubes, or belly of the mother ; 
when the face presents ; when a hand or arm enters the 
pelvis with the head. 

1. " The most common of the wrong head presentations 
is, that of the forehead to the pubes. It is seldom discov- 



179 

ered at the first examination ; the labour continuing 
longer than usual, the attendant makes a more accurate ex- 
amination, and discovers the presenting part is not so 
conical at the union of the pubes in front ; the bones do 
not ride one over the other ; the scalp does not form into 
a cushion j the hollow of the sacrum is not so filled up by 
the head ; the front fontanelle, with its square shape, and 
four seams or sutures, at each corner, may be felt. Na- 
ture, in general, particularly in those of large pelvis, will 
deliver in this presentment ; but there will be danger of 
laceration of the perineum, and the labour will be tedious ; 
all will be prevented, if the attendant will apply the 
fingers to the side of the forehead of the child, and care- 
fully press the fontanelle from the thigh bone, it approach- 
es, a little around, to the side or edge of the sacrum, 
whereby the crown of the child's head (occiput) is brought 
under the pubes in front, and the delivery is safely effected 
by nature. 

2. " The presentation of the face is distinguished, by 
the general inequality of the presenting part, by the eyes, 
nose, mouth, and chin ; the chin, in these cases, is towards 
the front of the pubes. These cases are generally to be 
left to nature ; the bones not yielding, the labour will be 
tedious ; the children generally born alive, but the fea- 
tures of the face are amazingly distorted, and require se- 
veral days of rest for recovery. 

3. " When, with the head, one arm presents, nature ge- 
nerally performs the work but slowly. This irregularity 
occurs chiefly in those of wide pelvis. If it be only the 
fingers or hand, coming down in a flattened shape, by the 



180 

bide of the head, the difficulty will not be very great ; if 
the elbow be the part, its fore arm bent on the upper arm, 
the difficulty will be increased ; and still more, if the hand 
and arm have descended before the head, the head resting 
upon the arm at the elbow. 

" Occasionally the operator may with the fingers pre- 
vent the hand or arm from descending below the brim of 
the pelvis, till the head progresses so low, as to be clear of 
the impediment ; but in attempting this, if the operator 
bring the arm down lower, or force the head back, no 
good, but great danger will be done. It will be very prac- 
ticable to push back the hand with a finger, without push- 
ing back the head, or pulling out the arm. The arm, in 
these cases, in general is much tumefied, but in a few days 
recovers itself. 

" In these cases unusual care must be taken to keep the 
patient calm, free from fever, cool, not sweating under 
hot clothes, and guarding against fatigue in vain attempts 
to force the chilcj, before the parts are properly prepared to 
let it pass ; opening occasionally her bowels with laxatives ; 
and never allowing the urine to remain in the bladder ; to 
which, in these cases, it is particularly inclined. 

" The next presentations are, first, those of the superior 
extremities ; second, the back, belly, or sides ; and third, 
the navel cord. These cases are only to be ascertained 
by feeling up the birth-place. 

* If, on an examination, the mouth of the womb be di- 
lated, and the child cannot be felt ; if the waters be eva- 



181 

fcuated, and the child oat of reach of the finger-, the pro- 
liability is increased of an unnatural case. 

1. " The most difficult cases are those of the superior 
extremities ; for, whether the part be the hand, elbow, 
shoulders, or both hands, it is impossible for the child to 
be delivered without being turned ; and delivered as a 
footling case. The established practice is for the opera- 
tor to pass the hand in the womb, to take hold of a foot, 
both if practicable, and bring them down to the external 
parts, and conduct the delivery as if it had occurred na^ 
turally. 

" The rules, in these cases, are, first to let the bag of 
waters dilate the parts. As soon as the mouth of the 
womb is sufficiently opened, or the waters evacuated, the 
attendant is gradually to dilate the external parts, till they 
make no further resistance to the passage of the hand- 
Then slowly carrying his hand through the birth-place and 
mouth of the womb, in the absence of a pain, he must 
(if they have not been opened) rupture the membranes, by 
pressing a finger firmly against them, when the hand will 
come in contact with the limbs of the child ; the hand is 
then to pass forwards till it reaches the feet, which are t& 
be drawn along the belly, not over the back of the child j 
proceeding slowly, still in the absence of a pain, it will be 
found, as the feet are brought lower, the arm will be re^ 
tracted ; and lastly, when brought down, that the case is 
become as a foot or breech presentment ; of which it must 
be particularly remembered, to turn the feet towards the 
sides of the mother, in order that the face may pass* 
at her back. These are the safest cases ; generally 

A a 



±82 

the waters are evacuated before the hand is introduce 
ed to prevent their passage ; and the womb contracts 
around the child, so 3s to make great resistance to the in- 
troduction of the hand. In such cases, and when the 
mouth of the womb is not dilated, the patient ought to be 
blooded freely, if she can bear it, to lessen the contraction ; 
and immediately after, (the better if fainting exists,) the 
mouth of the womb is to be dilated, and the hand insinu- 
ated as above. Lastly, when the action of the womb is 
so violent, as to make great resistance to the hand, it has 
been advised to wait, till the pain exhausts its powers. 
Dr. Hamilton prefers doing this, by administering eighty 
drops of laudanum. I would always advise free bleeding 
and bathing the parts, in large quantities of sweet oil, or 
melted hog's lard, and to keep warm wet cloths around 
the parts, to be often wrung out of warm water ; if not, 
So bathe the whole person in warm water, sufficiently long 
to produce a general relaxation. 

2. " The next presentation is that of the back, belly, 
and sides. In these rare cases, the child often spon- 
taneously turns into a breech presentment. When it 
does not, the introduction of the hand is necessary, to 
bring down the feet. 

3. " The presentment of the navel cord. In these 
cases the cord falls down, before the child, and is com- 
pressed, so that the death of the child is generally the 
consequence. When the pulsation of the cord ceases, the 
child is generally dead. Sometimes the cord has been 
slipped back out of the way of compression. If this can- 
not be done, and the child be living, after the part of the 



183 

child is engaged in the brim of the pelvis, the labour is to 
be hurried, by letting the woman stand up, by rubbing the 
belly, and by bearing down. 

In order to impress on your minds the more what 
has been said respecting the mechanical knowledge, and 
operations of labour, I recapitulate. 

First, If the after-birth be not delivered in about an 
hour and a half, after the use of the gentle means first sug- 
gested, the hand is to be introduced into the womb ; the 
fingers to touch and move against the sides ; then the pla- 
centa to be separated slowly? and brought away during the 
contraction of the womb. 

2. " In cases of twins, nothing extraordinary is re- 
quired in common ; if the second child be detained four 
hours, delivery to be forced as directed. 

3. " In breech presentments, the beginning to be left 
to nature : the presentment to be ascertained by the feel, 
the cleft between the buttocks, and the parts of generation, 
and discharge of contents of the bowels. When the heels 
pass, great care is to be taken to support the perineum ; the 
slower the labour so far, the better ; then as the body passes, 
pull a little the cord ; moderately extend the child, not so as 
to destroy its back and neck ; rub the belly occasionally j let 
the woman bear down ; let her stand up, leaning forward, 
that an attendant may properly support the child; when the 
arms appear at their origin, to pull them down gently ; rub 
the finger around the edge or the mouth of the womb, to 
excite it to contraction ; lastly, when the child's mouth ap- 



1&* 

proaches, introduce the finger, and pull down a little ; as 
soon as delivery, the woman to lie down, the child so 
supported as not to be injured ; air to be blown in its nos- 
trils, if not breathing ; the cord to be cut ; the skin to be 
rubbed, and every attempt made, and long continued, to 
reanimate the body. 

The standing up of the woman, as above, will proba- 
bly hurry the birth w r ith sufficient rapidity ; and I would 
particularly charge, that the child be so supported in its 
passage, as not to be endangered by the position; its weight, 
properly directed, must have a considerable effect in ex- 
pediting the birth. 

4. When the feet present, to be ascertained by the 
heel, the shortness of the toes, their straight edge, &c. ; 
and when the knees present, to be ascertained by the blunt- 
ness of the angle they form ; or when one foot, or one knee 
presents, the delivery to be effected as in breech cases, toes 
turned towards the thighs, on the passage of the breech. 

5. When the forehead presents, ascertained by feeling the 
front, or square opening, or fontanelle, with its four seams 
or sutures, and the cavity in the back or hollow of the sacrum, 
to apply the fingers to the side of the forehead, and turn 
or incline it around from the thigh bone of the mother, 
towards the edge or side of her back bone, or sacrum, 
where it unites to the hip bones, so that the presentation be- 
comes natural, which it often does, even without assistance. 

6. When the face presents, to leave to nature, pre- 
serving the powers of the mother, without excitement or 
•molestation, as cool and comfortable as possible. 



185 

7. When the hand or arm presents with the head, to 
endeavour, without pushing up the head, to push back the 
arm, (never to pull it forwards,) and, if not successful, 
still leave to nature. 

8. When one or two arms, the back, shoulder, belly, 
or breast, present, as soon as ascertained, and the mem- 
branes have opened the mouth of the womb, slowly intro- 
duce the hand, search for the feet, bring them down over 
the child's belly, thereby making a feet or breech present- 
ment. When the womb contracts so violently as to make 
great resistance to the entrance of the hand, the woman to 
be blooded freely, bathed around the body with sweet oil, 
fomentations of warm cloths to the belly, or general warm 
bath, to produce relaxation. Lastly, a large dose of lau- 
danum, not exceeding eighty drops. 

9. When thenavelcord presents, if early discovered, some* 
times it may be so pushed back, as to lessen its compression. 
The delivery to be hurried, to save the child, but not so as 
to lacerate the mother. The shortness of the navel cord 
is also sometimes an impediment to delivery : art does not 
here promise much : the cord has been cut, and the child 
died : the after- birth generally comes with the child. 

You must believe that there is nothing in these uncom- 
mon cases, which a woman of good sound sense, cool, 
composed, not in a hurry, could not perform. I would, 
in full confidence, trust to any such, especially if directed 
by a by-stander, in what manner to proceed, and directing 
from established, written rules. Nevertheless, where no 
such confidence exists, I would advise an application to a 



180 

physician, whenever there are rational grounds for believ- 
ing the labour will be tedious or difficult. 

I have now stated the difficulties at births, arising from 
the bad presentation of the child. These are, probably, 
not more than one half of the difficulties attendant upon 
child delivery. The powers of the mother are as liable to 
irregularity as the presentation of the child. Probably in 
confined manufacturing countries, the bad presentation of 
the child is not so frequent an occurrence as the mal-forma- 
tion and disease of the mother. 

The first impediment I shall mention to births, on the 
part of the mother, is the bad formation of the pelvis, a 
most rare occurrence indeed, in all countries like the 
United States, where children are brought up without that 
confinement, which destroys their vigour and make. The 
chief defect in the formation of the pelvis, is the projection 
of the back-bone too far forward, that is, near the front or 
pubes. The extent is ascertained by introducing the finger 
near the pubes, and moving it back to the most projecting 
part of the back-bone ; care being taken not to move it 
downwards, in the hollow of the sacrum. By this mode, 
it may be ascertained if the opening be three inches wide ; 
such are the powers of the mother, that often through a les- 
ser opening, of two and a half inches, children are born. 
When the presentment of the child is natural in cases where 
the pelvis is found small, the rule is to let the labour pro- 
gress, as long as the powers of the mother exist in good 
state ; but if no progress be made in the labour, that is, if 
the child do not descend at all in the pelvis, if the labour 
have continuedj so that the mother's strength is greatly im- 



187 

paired : lastly, if after consultation with the best profes- 
sional advisers, it be determined impossible to deliver the 
child living, the only object isthe safety of the mother : the 
child is to be brought away by pieces. 

The instrument for doing this is called the crotchet or 
perforating scissors. Dr. Bard's account of using them is 
annexed, as a subject of reference. 

u After a solemn and serious consultation, the operation 
being determined on, the woman is to be placed on her 
back ; the fingers of the left hand being introduced into the 
birth-place, and fixed on the presenting part of the child's 
head, (be sure the mouth of the womb is sufficiently open- 
ed,) the scissors made for the purpose, are then pushed 
through the palm of the hand, and between the fingers, and 
piercing the scalp to the skull, the bones are perforated by 
a boring motion, until the fingers reach the stops on their 
edge ;" (a much better plan is, when the sutures, or a fon- 
tanelle can be felt, to introduce the scissors through 
them, and destroy the organization of the brain ;) " the 
scissors are, when introduced, to be opened in one direc- 
tion, turning them half round, (the joints guarded by the 
fingers of the left hand,) they are to be closed, and opened 
again in the opposite direction ; and again turned round, 
so as to destroy the texture of the brain : then being closed 
with the same care not to entangle any of the soft parts of 
the mother, they may be withdrawn. Some time is now 
to be allowed for the woman to rest ; and for the pains, if 
they still continue, to produce their effect, in discharging 
the brain, and lessening the diameter of the head. 



188 

Ci I his being effected, we next endeavour to remove any 
ragged edges of bone which might injure the mother ; and 
then passing one or two fingers within the skull, and taking 
hold at the edges of the perforation, we may endeavour^ 
in that way, to assist the pains in forwarding the birth. 
But in a necessary and justifiable case, we shall be able to 
make but little progress in this way ; and we shall find it 
necessary again to fix the fingers of the left hand over the 
opening in the skull, and between them to introduce the, 
crotchet within ; then fixing the point on some of the 
bones ; with the left hand so placed within the vagina, and 
the fingers so spread on the child's head, as that the point 
of the instrument, should it slip, will rather strike the palm 
or fingers, than the parts of the mother ; we exert as much 
force, gradually increasing it in extracting, as the parts 
will bear : arid should they give way, the instrument is to 
be fixed again on another part, or on the outside of the 
head, in the eye, under the jaw, or behind the ear ^ and 
varying the direction of the extracting force, as far back as 
possible, from side to side, or directly forward, endeavour 
to bring the head through the contracted pelvis. If we 
again fail, both hooks may be fixed, one on each side of 
the head, by which as much force may be exerted, as can 
be necessary, or as the parts will bear : nor is it easy to 
conceive how much force, or how tedious and fatiguing an 
exertion is sometimes required. All, however, is to be 
done deliberately, slowly, and cautiously ; resting our- 
selves, and allowing the patient to rest, and, from time to 
time, to receive some mild cordial nourishment : haste is 
seldom necessary, and although we may wish the delivery 
accomplished as soon as possible, we must never be hur- 
ried," 



189 

" Having delivered the head, a cloth is to be wrapped 
round it, or a handkerchief round the neck ; by which we 
may make use of as much force as we dare, without risk- 
ing the separation of the neck from the trunk. And if 
even with this we do not succeed to bring down the shoul- 
ders and breast, which in a very narrow pelvis will some- 
times be the case, we are again compelled to have recourse 
to the perforator, to fix it in the arm pits, or to tear open 
the chest, or the abdomen, when swelled in consequence of 
putrefaction ; which, in a child long dead, is frequently the 
case. 

" This, as well as that in which the child's head may be 
enlarged by disease, particularly the hydrocephalus, are 
cases in which the perforator may be required, even in a 
woman with a well-formed pelvis. The hydrocephalus 
may be suspected, when in the beginning of labour the 
child's head readily recedes from the touch, floating as it 
were back in the waters of the womb ; or where, in a 
well-formed pelvis, the head remains a long time above 
the brim without engaging in it, notwithstanding active 
pains ; and at the same time, we can discover the sutures 
and fontanelles very largely open, and the bones very easi- 
ly moved on each other. Yet so much uncertainty always 
attends this conjecture, even in a person of considerable 
experience, that it becomes our duty to wait as long as the 
pains continue regular, and the woman's strength be not 
greatly impaired. 

" It will generally happen, that the expediency of intro- 
ducing the hand, and delivering the feet, with the hope of 
saving the child, will occur before we have recourse to the 

Bb 



190 

last remedy : this will put it in our power to examine 
carefully the nature of the case, and to ascertain what it 
is which obstructs the labour. If the head be not found 
very large, nor the pelvis very narrow, it may be proper 
to proceed, and deliver by the feet ; but if the head be 
found swelled very large, the chance of saving the child 
will be so little, and perforating the head, in this case, 
so easy and safe, that that may be most justifiable. The 
perforation in this case is generally all that is necessary ; 
as soon as the waters shall be discharged, the head will 
collapse, and the labour may then be left to nature. 

" The death of the child, when that can be ascertained, 
removes every objection to the use of the crotchet, when 
otherwise necessary. But of this there is but one real 
evidence ; that is the separation of the skin from those 
parts of the child, which can be felt. Neither coldness of 
the abdomen, disappearance of the milk, cessation of mo- 
tion for any length of time, nor even putrid and offensive 
discharges from the womb, are to be depended on. But 
the peeling off of the scarf-skin is unequivocal, and is 
sometimes attended with such a distension of the cavi- 
ties from extricated air, as to render it necessary to open 
them before the child can be born ; and for this purpose 
the scissors and crotchet are the most convenient instru- 
ments." 

But a great cause of difficult and tedious labours with 
mothers, is found, not in the bones, but in the womb ; it 
sometimes does not act ; it acts irregularly ; its mouth 
will not dilate ; its mouth is also subject to displacement. 



191 

The remote cause of these irregularities is most gene- 
rally an inflammatory state of the system ; marked by too 
violent action in the beginning of labour, sometimes by a 
prostration of the animal powers. Relief is had by free 
bleeding, even when the pulse is weak, if the person be of 
a strong, healthy make. In these cases a physician should 
attend, to judge of the power of the patient, and direct 
when delivery is to be forced. Constant attention must 
be paid to emptying the bowels and bladder in ail tedious 
cases. 



CAUSES OF TEDIOUS LABOURS. 

The first cause I shall mention of tedious labours is, 
the refusal of the mouth of the womb to dilate ; it re- 
mains rigid, as will appear from feeling it. The remedy 
most universally successful, is free bleeding, sometimes as 
much as forty ounces. A vomit has been often given with 
success. Filling up the birth-place with a large quantity 
of sweet oil, keeping the oil in by a plug of cork surround- 
ed by a rag, will be of great service. Sitting ever the 
steam of hot water is also beneficial. There is probably 
no case, in which these remedies, properly applied, would 
not relieve. These labours last sometimes many hours ; 
diet to be very low, and exercise taken freely, though not 
to fatigue. 

The next cause of tedious labour, is, the refusal of the 
body of the womb to contract regularly ; the pains are 



192 

irregular, but there is no contraction of the mouth of the 
womb ; bleeding in these cases is proper. Professor 
James, of Philadelphia, says, " from the repeated trials of 
the effects of spurred rye, (called ergot) that, when the 
soft parts concerned in labour are dilated to render the 
interior action more perfect, a dose of one scruple of this 
medicine, finely powdered, should be given, suspended 
in a little molasses and water ; that the dose may be re- 
peated in half an hour, if the interior contractions are not 
energetic ; that he never found occasion to give a third 
dose." This is a most important discovery j the medi- 
cine ought to be in every midwife's hands. I suppose it 
will nearly supersede the use of the forceps, for hurrying 
the birth. Nevertheless, as cases may occur in which it 
may not be safe to trust to this medicine, I extract the 
following account of the manner of using them. 

The forceps are made of two blades, corresponding 
to two levers, of shape and make as may be seen by re- 
ference to them in physicians' hands. The one part sepa- 
rates from the other ; and this one part, called a lever, in 
most cases, answers as well for hurrying the delivery, as 
the two united, called the forceps. Th^ manner of using 
each is as follows : after giving a clyster, and being cer- 
tain that there is no urine in the bladder, by introducing 
the catheter. 

The best position for the woman to lie, is on her left 
side, the posteriors near the edge of the bed. The opera- 
tor is to introduce the fore finger of the right hand to the 
child's ear ; then holding the blade or lever in his left 
hajad, he is, under his finger, which is his guide, to push it 



193 

slowly over the ear, till the claw of the blade i& at thf 
edge of the birth-place. The introduction of the blade 
will probably renew the pains, of which advantage is to be 
taken, by using the blade during the pains, and desisting 
during their intermission. The manner of acting is to 
hold the left hand on the blade, close to the birth-place ? 
and with the right hand to raise the handle of the instru- 
ment slowly, but firmly ; so that while the part held down 
with the left hand, keeps it fixed, the other end presses the 
child's head downwards, in the hollow of the sacrum, and 
thereby ends in the expulsion ; when there are no pains, we 
are to imitate them, by acting and resting alternately. The 
head soon begins'to descend, and distend the perineum, 
which is to be supported by an assistant. 

When, instead of this blade or lever, the forceps are to 
be used, after the introduction of the first blade above, the 
second is to be introduced with equal care below, precise- 
ly opposite to the first. Should the opposite ear not be 
felt, the direction of the blade must be by the position of 
the first. 

Both blades being most slowly introduced, the claws are 
to be brought together and locked, care being taken not to 
entangle any of the hair, or soft parts, in the lock. 

If, on endeavouring to lock the forceps, the handles do 
not come near together, or are very far apart, or are close 
together, the points of the blades are not properly fixed ; 
the last one should be extracted, and more carefully 
fixed. 



1M 

The forceps being so fixed as to enclose the head of the 
child, tjie handles being held in both hands, they are to be 
moved from handle to handle, or upwards and downwards, 
or from ear to ear ; because, if moved from side to side, 
or face to crown, they will slip off. The most gentle force 
only is to be used. Dr. Meriman observes, " when acting 
with the forceps, the force at first used should be very mo- 
derate, but is to be increased as occasion may require ;" 
yet if the head advances at all, however slowly, with the 
force first applied, it need not be increased ; for as Dr. 
Denman truly remarked, " a small degree of force, con- 
tinued for a long time, will be equal to a greater force 
hastily exerted ; and with infinite less detriment either to 
mother or child." 

In concluding this short sketch of the use of instruments, 
so terrible to so many ladies in imagination, I would remind 
you of the folly of such fears. What are these mighty in- 
struments ? a pair of scissors, to cut as they open, digni- 
fied with the name of perforator, as harmless to the mother 
in this operation, as proper to be used, when the child can- 
not be born living, or is dead. And what are the forceps ? 
a pair of large pincers 1 one blade, when used alone, dig- 
nified with the name of lever. And as to their use, a 
source of no pain to mother or child, requiring not more 
sense for fixing them over the ears of the child, so as to 
compress its head equally, and not injure the mother, than 
the application of a pair of pincers to pull out some body 
from a mass which a little surrounds or envelops it. Tak- 
ing this fair view of the subject, I think that although not 
one in half a million may have to submit to the operation, 
all ought to view it as a simple aflair, without any terror ; 



195 

really not so dangerous or painful as the extraction of a 
tooth. 

I now come to the third cause of tedious labours. It is 
when the mouth of the womb is turned towards one side 
of the woman ; or thrown backwards to the back of the 
pelvis, so as nearly to reach the sacrum ; or thrown for- 
wards over the pubes. 

Laying on the opposite side will change the leaning of 
the mouth of the womb. 

When the mouth is turned backwards, (which occurs 
sometimes with those of very pendulous bellies,) it is re- 
commended to lay on the back, the hips elevated ; and it 
may prove of service to support or push towards the back 
bone or spine, the top of the womb, it being the part 
nearest the stomach. The fact of this inclining backwards 
of the mouth of the womb, will be ascertained by intro- 
ducing the linger up the birth-place, and finding the mouth 
of the womb not in its proper place, but pushed away back- 
wards, scarcely in reach of the finger. In these cases, the 
head £nters the pelvis, the part nearest the pubes being co= 
vered with the front of the womb, which has been mistaken 
for the child's head, without hair. The delivery requires 
patience, and no interference. 

The bending of the mouth of the womb forwards to the 
pubes, has been questioned ; if it ever so incline, the treat 
ment is to leave to nature. 

Before concluding the subject of delivery, I will remark 



196 

iwo cases of most rare occurrence, and attended with great 
danger. 

The first is, when the after-birth adheres to the mouth 
of the womb ; and at its dilatation, bleeds freely. By the 
introduction of the finger, the orifice of the womb will be 
felt dilating during a pain. The practice recommended in 
these cases, is to introduce the hand, gradually dilating the 
parts, to push it through the body of the after-birth, feel 
for the feet of the child, and deliver with as much rapidity 
as in footling cases ; as is practicable without bursting the 
parts of the mother. Although I never had such a case, I 
would strongly recommend in preference, two doses of the 
ergot, the one half an hour after the other; at the same 
time introducing up the birth-place a strong solution of 
sugar of lead, the buttocks elevated, a tight plug in the 
birthr place, then to cover the external parts with the hand, 
firmly pressing to prevent the escape of blood, until the 
head of the child advances. So long as the womb con- 
tracts, no blood can flow, if you will prevent its passage 
externally, which I am sure, by hands to relieve each other, 
may be done till the ergot operates. When there are no 
pains, then turning, and delivery by the feet, is the only re- 
source. 

The second case is attended with convulsions. These 
often arise from irritating matter in the bowels. The re- 
medy is bleeding most freely ; at the same time, pour down 
the throat either ten or fifteen grains of calomel, or any 
other purgative medicine. In addition, a solution of a 
spoonful of salts ought to be given j also a clyster every two m 
hours, until the purging is free. When the stools are o£« 



197 

lensive, their irritating nature will be greatly lessened 
by giving the patient a tea-spoonful of chalk, or half as 
much salt of tartar, or what is nearly the same, a table 
spoonful of common strong ley, every two hours, either 
mixed in milk or water. When the head of the child is 
low in the pelvis, it is advised to hurry the delivery with 
the forceps. 

My solicitude to make one and all of you acquainted 
with the history of child-bearing, induces me to add an ac- 
count of some cases which may occur in every family, as 
well as the offices performed by attendants. The perusal 
must make you more familiar with the subject, and the 
better enable you to assist, some suffering woman, or even 
to direct the performance of services to yourselves, 

Case 1. Mrs. A. was taken in labour with her first 
child; She had indulged in excessive fears, increased by 
the accounts her attendants and companions gave of dread- 
ful accidents they heard of at other births. She was con- 
vinced that her situation was deplorable, that the birth 
would end in her death. Her pains, extending around her 
back and belly, were at regular intervals. The midwife 
was sent for, and in obedience to her fears also, a man at- 
tendant, to be ready in case of accident. When the mid- 
wife arrived, she requested the patient to lay on her left 
side ; and having her nails closely cut, without any oint- 
ment, introduced up the birth-place the fore-finger of her 
right hand j at first near the pubes or front bones, then ex- 
tended it backwards towards the back bone, called sa- 
crum, from which she perceived at once, there was a con- 
siderable space, abundant for the passage of any common 



198 

child. She kept her hand in the birth-place or vagina, un- 
til a pain came on, and then, with perfect gentleness, ex- 
tended her finger towards the middle, to the mouth of the 
womb. She found that the orifice had opened a little, that 
it was on the stretch during the pains or contractions of the 
womb ; she felt a small presenting part of the membranous 
bag containing the waters ; and desisting from pushing, 
lest her finger might burst the bag, she withdrew it a short 
distance, preserving it at ease in the birth-place, until the 
pain had subsided. When this was ended, she moved her 
finger around, and felt the hard head of the child, but 
could not of course perceive the hair of its head. Though 
it were possible for her to be mistaken, yet she affirmed 
that it was the head, and told her patient that all was right } 
that her case was very favourable. The midwife next 
charged her to evacuate her urine whenever she felt the 
least inclination; and had an injection of warm water 
given to open* her bowels ; which speedily had the effect. 
The pains returned at regular intervals, increasing in fre- 
quency as the labour came to a close. As the mouth of 
the womb was opening, tfce woman said she felt as if Cut 
open with a knife, so excruciating were the pains. The 
bag of waters protruding through and dilating the part, at 
every point, the head soon descended. In this state, dur- 
ing every pain, the bag or membranous covering was much 
distended, feeling as a bladder ready to burst. When the 
pain was over, the waters receded, the bag became flaccid, 
and it was very practicable to feel the round crown of the 
head of the child, the soft part in its skull called fontanelle, 
and the pulsation of an artery in its head ; which proved 
that it was living. Presently the pains became more fre- 
quent, the head of the child perceptibly descending, when 
the patient was improperly alarmed at a gush of water 



199 

escaping from the birth-place, which arose from the timely 
bursting of the membranes : now the external parts began 
to distend, the head being in the birth-place, the pains be- 
ing more frequent, the head would descend almost to the 
external parts, and when the pain ceased, would go back 
considerably. The midwife saw that this was the critical 
time, and kept the patient on the bed, on her left side, her 
knees drawn half way up to the belly, and a pillow between 
them ; also large cloths underneath her, to preserve the 
bed. In this situation she sat at her side, her right hand 
applied so as to cover the part called the perineum, (being 
between the fundament and birth-place, now very thin, and 
spread so as to appear four or five times as wide as com- 
mon.) On this equally, she kept her hand, to prevent the 
too rapid expulsion of the child ; and when the head was 
advancing, held her hand pressed against it, so as to push 
or incline the head towards the pubes, or front of the wo- 
man. Being the first birth, she thought the child might 
tear the perineum in its passage, therefore held her hand so 
as to resist altogether the exit of the head during two pains, 
so that the parts had better time to dilate. In this stage, 
she took unusual pains to direct the attention of the wo- 
man from bearing down, or holding in her breath, inducing 
her to talk all the time. At last the head passed into the 
world, the face towards the mother's back or fundament : 
the midwife all the time keeping her hand on the part until 
the pains of the woman expelled the buttocks of the child. 
After the head passed, an additional quantity of water 
escaped, it being squeezed out by a pain, which in a few 
seconds returned. The head of the child was supported by 
her left hand, until the expulsion of the body, which was 
completed in two minutes : care was taken from the first 



£00 

sappearance of the mouth, that air should freely be admit* 
ted, as also that the navel cord was not compressed. About 
six minutes after the delivery, the child crying loudly, and 
the pulsation of the cord lessening, she tied a string once 
around it, about two inches from the navel, then another 
string towards the mother, within two inches of the first, 
then cut the navel cord between the two knots, with a pair 
of scissors. In about ten minutes after the delivery, the 
happy feelings of the mother began to cease : she felt the 
pains returning. The womb still contracted ; it was felt 
as a large ball over the pubes j the after-birth made its ap- 
pearance at the birth-place ; and with considerable clots Gt 
blood, was taken away, and put in a pot for the purpose of 
burial or burning. The patient was kept unmoved during 
this operation ; and about ten minutes after, her bottom 
was raised a few inches, the wettest cloths pulled away, and 
dry ones put under ; and then she was wiped as dry and 
clean as practicable, without any exposure to the cold air : 
here she continued about an hour. After this, without 
raising her head, she was rolled over to the other side of 
the bed, a small bundle of rags put at the edge of the birth- 
place, and a sheet folded up and pushed under her bottom, 
where she was left to repose. 

The only drink iaken from the beginning to the end 
was cold water, and weak cold tea. The midwife had only 
to introduce her fingers from time to time, and always 
most gently. She had not her hand thirty minutes on the 
perineum to prevent its tearing ; and excepting the tying 
the navel cord, and guarding against pressure on it, keep- 
ing the child's mouth exposed to pure air, she did nothing, 
except prevail on the patient to be quiet, and not disturb 



201 

the operations of nature, by using her powers in bearing 
down. As soon as the navel cord was cut, the child was 
handed to a nurse, who kept it in her lap, covered, excepting 
its mouth, in a warm cloth. As soon as warm water could 
be got ready, it was put in a tub and washed, then dress- 
ed in light clothes, so that its limbs could move. In six 
hours it was applied to the breast. 

This case, conducted by a sensible midwife, is pretty 
much the history of ninety-nine cases out of the hundred, 
of common deliveries. The offices, required in such 
cases, surely no woman can hesitate in admitting, may well 
be performed by the most ignorant servant in the family. 
The only office is keeping the hand against the perineum, 
which might safely be dispensed with, if the mother woulif 
be sure not to bear down to hurry the birth. 

Case 2. Mrs. B. was in labour with her third child. 
The midwife not being properly instructed, with too much 
violence pushed her fingers, during a pain, so that it burst 
the membranes, and the waters were discharged, before 
they had assisted in dilating the parts. The birth was, in 
consequence, attended with more pain, but in other re- 
spects terminated favourably ; excepting that the bowels 
not being evacuated, at the birth of the head of the child, 
considerable quantity of excrement was expelled. 

Case 3. Mrs. Ci in labour with the second child, took 
an injection, as all ought to do in that situation. The 
membranes burst in proper time, and the child was born 
without any accident. But there w T as considerable delay 
in the delivery of the after-birth, which excited some un- 



202 

easiness. The ball of the womb was felt in the belly ; 
the midwife moved it about ; at last she introduced the 
finger, and turned it around the edge of the womb, which 
produced a return of pains j as the pain came on, she 
gently extended the cord, and the whole came down into 
the birth-place ; she then received it, turning it round, so 
as to wipe up, and bring along the membranes. 

The following cases from Dr. Bard, I annex, as they 
more fully explain the treatment for the inversion of the 
womb, than I have done in the account of it. They will, 
at least, serve to remind you of the folly of pulling away 
the after-birth with violence ; and the impropriety of wo- 
men standing up at delivery, excepting where indispensa- 
bly necessary to save the child. 

Case 4. " A lady, very tall, after a labour rather te- 
dious and severe, was at last, by one long and severe pain, 
delivered of her second child. On tying the navel string, 
I observed it to be remakably thick, and very short, and 
on taking hold of it between my thumb and finger, (for I 
could not twist it round my finger,) I perceived, as I 
thought, the placenta to be descending ; not however by 
successive pains, but by one interrupted descent, until it 
was thrown out of the vagina ; and to my very great 
astonishment, with it came the whole volume of the womb. 
It is not easy to express my feelings at this moment ; still, 
however, I commanded so much presence of mind as nei- 
ther to lose my time nor alarm my patient. The placenta, 
which was already in part separated, was immediately de- 
tached ; and my fingers being applied to the fundus of the 



203 

womb, it was immediately and completely reverted ; the 
hand and arm being introduced as high as the elbow, then 
slowly withdrawn. No flooding or other ill consequence 
ensued, and the patient speedily recovered. It was seven 
years before this lady became again pregnant ; her labour 
was then natural and happy ; she has since had a fourth 
child, and now enjoys good health." 

Case 5. "The gentleman who communicates this case 
to me, found the patient in the very last stage of labour ; 
standing, supported by her friends, in a very awkward pos- 
ture, between upright and recumbent. The child was 
born in this posture, immediately after he entered the 
room; the navel string was wound round the neck, and 
the greater part of the placenta protruded the external 
orifice, slightly adhering to the fundus of the womb, which 
was found very low down in the vagina : no flooding en- 
sued. The case being perfectly new to the physician, he 
contented himself with gently pushing up the fundus as 
high as he could with his fingers ; and ordering himself to 
be sent for in case of flooding or any unusual occurrence, 
he went home to reflect upon it. In about eight or ten 
hours, the husband called on him in great agitation, and 
informed him, that a substance as large as an ox's bladder 
blown up, had come out of the vagina. In this situation 
he found his patient, with very little haemorrhage, but very 
faint, and a pulse not to be felt at the wrists. He imme- 
diately grasped the womb with both hands, and compressed 
it until he could grasp it with one, then, with the fingers 
of the other, he pushed the fundus through the external 
and internal orifices, pursuing it until he had' restored it to 
its natural situation ; and letting his hand remain until the 



womb contracted about it, then gently withdrew it. The 
faintness immediately went off, the pulse returned, and the 
patient had a quick and good getting up. It is now nine 
years since this happened, the woman has enjoyed good 
health, her menstruation has been regular and moderate, 
but she has never since been pregnant. 

Case 6. " A lady, after a labour rather severe, was de- 
livered of her first child ; the placenta did not follow in 
less than two hours, and was then delivered with so much 
pain, that, from that circumstance, as well as from what 
followed, there is reason to believe much mismanagement 
occurred. For some time before the delivery, a suppres- 
sion of urine took place, which continued unrelieved above 
three days ; during ail which time, in addition to much, 
pain, she complained of a continual nisus, as if something 
was to come away. On the fourth day, while sitting on 
the pan, and endeavouring to pass her urine, the whole 
womb was suddenly thrown out of the vagina. It was 
eight or ten hours before medical assistance could be pro- 
cured ; but in the mean time, the nurse, a prudent and ex- 
perienced woman, grasped the womb, and endeavoured to 
replace it ; and actually saved the patient's life, by pre- 
venting the midwife from rudely attempting to bring it 
away ; which she insisted on doing, asserting it to be a 
part of the placenta left behind, By the time the physi- 
cian arrived, the nurse had so far succeeded as to replace 
the womb within the vagina ; the urine was immediately 
drawn off by the catheter, but it was then found to be im- 
possible to revert the womb. For upwards of thirty years, 
this lady remained subject to profuse haemorrhages, and 
consequently endured a very feeble state of health, but has 



205 

survived until the menses have ceased, and now enjoys a 
perfect state of health." 

Case 7. " A lady, after a labour in all respects per- 
fectly natural, was delivered of her fourth child on Sun- 
day. The gentleman who attended, assured me, that no 
force was applied to the navel string, but that the placenta 
was delivered by the natural pains ; on examining after the 
deliverance, he discovered a tumour in the vagina, the 
nature of which did not immediately occur to him ; a 
slight convulsion and a considerable bleeding ensued, 
but soon ceased. Apprehensive of renewing the bleed- 
ing, no further examination was made, and the lady was 
put to bed, apparently as well as she usually had been. 
The usual after-pains followed ; in addition to which, on 
Tuesday night she complained of much uneasiness, and a 
feeling, as she expressed, as if something wanted to come 
away : and on Wednesday morning, after a throe a little 
more severe, the womb was protruded from the vagina, as 
large as a pint decanter ; and resisted every attempt that 
was made to replace it. I saw the patient at noon of the 
same day, after which, such attempts as were thought jus- 
tifiable, were again made to revert the womb, and persisted 
in above an hour, in all the variety that could be devised, 
but without any sensible effect. An emollient fomenta- 
tion was then directed, and the protruded womb" was or- 
dered to be covered with a piece of fine linen, spread with 
simple ointment, (sweet oil is best,) and to be suspended by 
a bandage ; the bowels to be kept open, the bladder empty, 
and every means to avoid inflammation to be strictly pur- 
sued. After this, two women, who both professed to have 
seen and relieved similar cases, were successively applied 

Dd 



306 

to i and both appeared to have treated the complaint very 
properly, with soft emollient applications ; and the last 
particularly, to have persevered with great attention and 
tenderness. Under this management, the protruded womb 
gradually diminished in size, and after seven or eight days, 
that is, on the Tuesday or Wednesday following, with very 
little assistance, was suddenly retracted from the hand in 
to the vagina. 

OF LESSENING THE PAINS OF LABOUR. 

I come now to the means of lessening the pains of la- 
bour. The first point I wish to impress on your minds, 
is, that labour being an operation in which the whole sys- 
tem is greatly concerned, the main object is to preserve 
the general health. I have already told you, that washing 
and rubbing the skin, especially in parts where there is 
great secretion ; that a plain, simple diet, regularly taken, 
with exercise in open air, are indispensable requisites for 
health. You are already apprised, that the confined con- 
tents of the bowels generate such stimulating, offensive air, 
as to distend, and excite to diseased action the womb and 
neighbouring parts, all effectually prevented by daily eva- 
cuating the bowels at the same hour. I state it as an in- 
controvertible truth, that almost universally the woman 
who preserves her health by diet, exercise and cleanliness, 
instead of by physic, will have infinitely the best time in 
child-bed. 

It has been urged, that a free use of sweet oil in diet, 
tends to lessen the pains of labour. I have seen cases 
where many believed it to have this effect. Its free use in, 



207 

bathing the belly, and around the thighs, in injecting it, 
and retaining it up the birth-place, as labour advances, 
certainly tends to lessen considerably the painful irritation 
and distension. 

But of greater efficacy, of greater certainty, I recom- 
mend the loss of blood, when labour commences. It has 
been recommended by the ablest physicians in this coun- 
try. I have never seen a person who resorted to it, who 
failed having an obvious mitigation of suffering. Abun- 
dant diet, the high action of the system, converting the fat 
into blood, give sufficient reason for its universal use, ex- 
cepting in those enfeebled by disease. In addition to less- 
ening the pains of labour, it lessens the diseases apt to fol- 
low. It is impossible to give you directions applicable to 
each case, but I would recommend to all who are four 
hours in labour, to lose from ten to twenty-five ounces of 
blood, according to their vigour, unless reduced by dis- 
ease, as before remarked. There is nothing which will 
so lessen the painful contractions of the womb, and dis- 
tension of the exterior parts ; so effectually prevent their 
inflammation, and the subsequent diseases of the constitu- 
tion, which destroy so many, 



209 



LETTER IX. 



Contents. Treatment of lying-in women to prevent then 
diseases — of their milk — diseases of the parts concerned 
at birth — offaintings — chills — local pains and inflamma- 
tions of the parts — after-pains — inflammation of breast 
> — sore nipples — milk fever — puerperal fever — miliary 
and common fevers — swelled leg and mania. 

The proper management of women after child-birth, is 
a most important subject. The great irregularities and 
errors in the common treatment of lying* in women, have 
caused physicians of the best abilities, to take the subject 
into consideration. The result has been the unquestion- 
able establishment of a course in direct opposition to the 
old. 

Most of your sex indulge in great apprehensions of the 
dangers of bringing forth ; they seldom fear the hazards of 
the succeeding month : but I will venture to assert, that 
two women have died from mismanagement after delive- 
ry, for one at delivery. It is an established fact, that our 
systems very well endure even the excesses of any one 
state continued : in any wet, dry, cold, or hot climate, our 
bodies will be in perfection ; but the moment changes are 
made, the animal powers are affected and diseased. The 
delivery of the great mass contained in the womb, which 
for nine months it had soiiighly stimulated, is a change 



210 

producing as great a revolution in your systems, as any to 
which your bodies are exposed. It is at this revolution 
that diseases enter, over power, orundermine your consti- 
tution ; and that the exertion of the greatest wisdom is 
demanded for your escape. 

You have been told that your systems, during pregnancy, 
were in an inflammatory state, marked by quickened pulse, 
and the buff coat appearing in your blood when drawn. 
The evacuations at delivery lessen, but do not relieve it. 
A fever of considerable action follows ; an over secretion 
of milk marks the excitement, necessarily increased by 
stimulants and confined air. 

With such facts, would you believe, if you had not heard, 
and probably often seen, that it is most customary to dose 
women after delivery with spirits, wine, and spices ; their 
heat and exhalations retained, still more stimulating their 
bodies ; and the contamination of the air they breathe, in- 
creased by bed curtains and closed doors ? 

I have already suggested to you the selection of the 
largest room in your houses for delivery. I would press 
that from the beginning to the end, the door should be 
kept a little open. The current of air should be kept off 
with a screen, not by bed curtains. Every thing filthy 
should instantly be removed from the room : old carpets 
among the number, unless effectually washed. The clean- 
est room about a house, should be that used for lying-in. 
Frequent cleansing, and a free admission of fresh air, are 
to be had, without exposure to cold. True that nothing 
is more destructive to women than receiving colds after 



211 

child-delivery ; but those are ten times more subject to 
them, who are confined to a close air, than those who are 
not. I am sure, by the exercise of your own sense, you 
will always find means to keep your bodies comfortable, 
neither oppressed with clothing, or so exposed as to re- 
ceive colds. 

The treatment every woman requires after child-bear- 
ing, is almost precisely that directed for the small pox. 
By following that course, you will find benefit equal to that 
which was found on substituting a cooling diet and air, for 
the heating, stimulating practice pursued formerly, with 
those who had the small pox. 

After a woman is wiped dry, and rolled over, or lifted 
up, to the other side of her bed, she should, if not disa- 
greeable, lie on her back, with a pillow on her belly, which 
will produce a moderate compression on the parts. The 
more perfect her rest, the better ; there should be as little 
moving as possible. The child should always be applied 
to the breast before six hours elapse, after washing the 
nipple in warm water, to take off the bitter matter adher- 
ing. Those who have had much loss of blood at the de- 
livery, will probably be long in having the milky action in 
their breasts. To such, as to all doubtful of having milk 
in time, I would strongly recommend the application for 
an hour or two, of a large, soft, warm poultice of bread 
and milk, around and over the nipple, which will foment 
the parts, and promote the secretion of milk, with less fe- 
brile exertion of the system. 

At the beginning of the second day after delivery, and 
never later, every woman should have a flannel roller, or 



212 

some kind of compression applied around her belly. This 
is not designed to make her sides grow together ! there- 
fore it is to be moderately close, rather loose. It should 
be continued during her month's confinement, so that the 
sides of the belly being kept from distension, her belly 
will not be so apt to protrude or distend, after the recove- 
ry. A tight, instead of a simple supporting bandage, is in- 
jurious. On the second day, a dose of castor oil, or mag- 
nesia, or salts, ought always to be taken, if the bowels 
have not been opened since delivery. An injection of 
warm soap and water will answer, if the medicine be ob- 
jected to. You have no idea of the degrees of disease 
brought on by neglecting to do this. The bowels have 
been in an unusual state, and their diseased action is rea- 
dily excited, by the confined contents. One third of the 
women who have died, while lying in, I am convinced, 
have perished from neglecting to evacuate their bowels. 
Indeed, I know the importance of it so well, and feel such 
anxiety for your escape from disease, that I most earnest- 
ly entreat you, for your own and your child's sake, never 
to let more than twenty-four hours elapse from the hour of 
delivery, until your perfect recovery, without having an 
evacuation from your bowels, naturally if you can, but if 
not, by the artificial means of introducing a piece of soap in 
the fundament, or of an injection, or a laxative medicine. 

The proper place to have this evacuation is in bed, lying 
over a bed pan, which ought to be in every house. When 
they are not to be had, a piggin with an additional hoop 
at bottom, sawed off, two inches from the bottom, then 
covered with plank ; this top to have a round hole made 
in it, then to be screwed or tied to the piggin, will 



MS 

answer as well as the best bed pan. The cost will not ex- 
ceed a dollar ; and take ni) v advice, always to have one in 
readiness in your families ; it will often be of service, it 
may even be instrumental in preventing an exhaustion, 
which might end in death. 

The next thing I wish most earnestly to recommend, is, 
to wash the birth-place every day in warm soap and water 
after delivery, for at least one week. It may be done un- 
der the bed clothes, a little elevated at bottom. A basin 
pushed under the breech is all the preparation necessary. 
Women in confinement ought to have a syringe for injec- 
ting in the bowels, and the same will answer to squirt 
warm water up the birth-place. The utility of taking 
away the irritating secretions from the parts after deli- 
very, (called lochia?,) is indeed truly great. The retention, 
inflaming the womb and bowels, has been a great cause of 
the fevers of lying-in women. This discharge generally 
lessens on the third day, when the breasts distend with 
milk j it varies considerably in smell, colour, and quanti- 
ty. These changes in smell and colour, arise chiefly from 
the varying putrefactions or fermentations it undergoes af- 
ter it is secreted by the vessels of the womb. I mention 
this, to induce you to be the more particular in its remov- 
al. The quantity of the discharge differs in almost every 
woman. It indicates the degree of increased action in 
the womb. When it is suddenly suppressed, as it is by 
improper exposure to cold, the remedy is to bleed a little, 
to foment the belly by cloths, taken from hot water; to give 
a purge and clyster immediately. Whenever it is of a very 
offensive nature, by all means inject, with considerable 
force, warm soap and water up the womb ; it will assist in 

k e 



the expulsion of the clots of blood that may be detained 
and in other respects will be of great service to the sys- 
tem. A common squirt, made of elder, will answer the 
purpose ; and I beseech you to inject soap and water 
freely, if not daily, at least on the slightest appearance of 
disease. 

The linen should be changed every day during confine- 
ment ; and dry cloths pushed underneath the breech, 
which can be done by a good nurse, without disturbing 
the patient. 

DIET. 

The next subject I have to press on your attention, is 
the proper diet of a lying-in woman. 

And the first remark I have to make, is, that the intend- 
ed kindness of women to each other in this state, has de- 
stroyed more than it has saved. The diet of our peni- 
tentiaries, bread and water, would have proved a blessing, 
from the highest to the lowest of your sex, if it had been 
strictly adhered to for the first two weeks after delivery. 
I could scarcely name a disease which has not been brought 
on, either directly or indirectly, by the cramming of strong 
stimulating food during their confinement. 

It is not my intention to recommend almost starvation, 
as has been done so extravagantly by some writers : but 
moderate diet. I would advise every woman to eat small 
quantities of food ; bread, potatoes, rice, barley, or any 
vegetable body, nothing heating, no spices, from the 



215 

beginning precisely at the same hours the meals are taken 
in health. The keeping up the habitual action of the sto- 
mach, has a powerful effect in keeping off diseased action. 
The quantity the first day should not be much; but after 
the second day, the bulk taken may be as much as the per- 
son was in the habit of eating. 

Not till the first week passes, would I consent that meats, 
butter, and very nourishing articles, as cream custards, 
&c. should be taken. Nor would I agree to a return to a 
free use of meat for several days. The drink during this 
whole time, should be good strong water ; weak tea, or 
gruel ; towards the last, if any, very mild soup. A gruel 
made of oat- meal is greatly esteemed by many ladies. 

Unless prevented by good reasons, every woman should 
sit up a little in her bed, the day after delivery, for half an 
hour or an hour ; she may be supported with a chair and 
pillow at her back. This sitting up promotes the natural 
evacuations from the birth-place, and should be prolonged 
every day, not enough, however, to fatigue. Sometimes 
this is attended with fainting-feeling ; which, when there 
is no flooding, it will, notwithstanding, be proper to perse- 
vere, as it speedily goes off. The woman should not stand 
up before the fifth or sixth day ; and not leave her room 
before the seventh or eighth ; and then but at short inter- 
vals. In making these changes, a middle course is to be 
observed, neither to be exposed to a current of air, or op- 
pressed with warm clothing. 



u 



Dr. Moss, the judicious writer before quoted, says. 
The treatment of lying-in women, has been, till very lately. 



216 

universally founded upon the supposition that, from the 
moment of delivery, and for a certain time after, they could 
not have too frequent and plentiful supplies of warm liquids, 
cordials, and nourishing food, in the form of gruel, of dif- 
ferent sorts, made with spices, with the addition of wine 
or spirits ; and that an unusual degree of warmth and 
sweating was to be kept up bjr these means, further sup- 
ported by the warmth and closeness of the room, confine- 
ment to bed, and additional quantity of bed clothes. All 
this was done with a view to support and recruit the 
strength and spirits, and to keep off cold and its effects. 
However, these opinions and practices are proved by ex- 
perience, not only erroneous, but to produce the very evils 
they were intended to lessen and obviate. 

" There is, from the time of delivery, a constant, par- 
ticular, and natural propensity and disposition to fever, 
which gradually increases the first three or four days, and 
is a source of great danger. Whatever will add to the 
heat of the body, or action of the system, will increase and 
prolong this fever ; than which, nothing is more calculated 
than wine, spices, cordials, and liquids of all kinds taken 
hot, with unusual warmth in the room and bed. A person 
in the highest health, so treated, would most likely have a 
fever : and it is easy to conceive how nfuch the milk fever 
of women, and all its consequences, are to be aggravated 
by such treatment. 

tc A coldness and shiverings very commonly accompany 
all feverish complaints, and of course very common at this 
time ; which may have led to the notion of the warmth, and 
warm things being proper, by way of preventing them, and 



217 

removing them when present : but this is a false and mis- 
taken opinion ; for whatever brings on the fever, may be 
said to bring on the shiverings also, as the shiverings will 
not come on if the fever is kept off ; and when the shiver- 
ings are actually present, the most heating things will not 
lessen or abate them, so as to do good : therefore no more 
than a moderate warmth should ever be employed for that 
purpose. 

u The sweating which is brought on by this warm treat- 
ment, has also been supposed necessary to prevent or carry 
off any degree of the fever, and to prevent the shiverings ; 
but which is a notion as fallacious as the other, as it not 
only serves, when in excess, or long continued, to support 
and increase the fever, but exhausts the strength and spirits. 

" Those who lie-in, are sensible how liable they are to 
be over-heated, by the most trifling additional heat of the 
room or bed, or by taking any thing warm, which makes 
them feel very uncomfortable and uneasy to themselves ; 
often have the head-ache, perceive a faintness, weariness, 
and depression of spirits ; all which continue, and are in- 
creased, according as the heat and heating things are re- 
peated ; and are the symptoms of the feverish complaint 
mentioned. On the contrary, they who are never exposed 
to be over-heated by the warmth of the bed, the room, or 
what they take, seldom or never experience these disagree- 
able sensations, but feel comfortable and easy to them- 
selves, and find their strength and spirits increase apace ; 
all which desirable circumstances, with many others, are 
entirely effected by subduing and keeping off this feverish- 
ness, by cool treatment." 



218 

You will, ladies, be well paid for imposing on yourselves 
these restraints after delivery. Give no attention to the 
stories of perfect recovery under a different treatment. I. 
beseech you to bear in mind, that it is not so much on ac- 
count of present exemption from disease, as to save your 
constitutions, which at some future day will suffer for your 
transgressions. After this operation of delivery, your sys- 
tems are in their most delicate state ; from the most in- 
considerable causes, sensibly or insensibly, they become, 
or will become, most seriously affected. To conduct you 
with safety through these changes, far more skill is requi- 
site than for the delivery of your offspring. Indeed, for 
the latter, wise nature is the actor ; for the other, manage- 
ment ; the directions of our confined minds are to come in- 
to operation ! Do not understand me as saying that you 
must consider yourselves as patients, requiring doses from 
doctors : you only require the hourly exercise of common 
sense. Be quiet in mind and body : most gradually let 
your systems be restored to their common state and action, 
by returning to your habitual diet and exercise in slow de- 
grees : subdue all inflammation on its first approach, by 
abstinence, and by evacuations. These are the suggestions, 
not so much of medical knowledge, as of common sense. 
Observe them ; and if in other respects you do not act 
in opposition to the dictates of this common sense, you 
will pass through child-birth with a safety greatly superior 
to that of the generality of your sex. 

OF GIVING MILK. 

I have now to urge the necessit)' of all mothers suck- 
ling their own children, if they desire to preserve their 



219 

health. It is to me a subject of astonishment, how any 
woman could be so lost to the feelings of nature, as to 
give up the pleasure of this undertaking. As they are not 
alive to the joy of furnishing the food from their own bo- 
dies for their babes, they ought to be solemnly warned of 
the efFects on their own constitutions, by such neglect. Such 
is the wonderful nature of the system, that no one func- 
tion can be suspended, without its having some influence 
on other parts of the body. Unless every part goes through 
its natural action, or irritation, some other part of the bo- 
dy will, even at most distant days, take on an action of dis- 
ease, equal in extent, and more fatal in consequences. The 
womb, I believe, never properly performed its office, when 
not relieved by the determinations to the breasts. Nor is 
this the only evil ; for a little while you may escape dis- 
ease, but at last you will suffer greatly for not conforming 
to nature in suckling your children. Cancerous womb and 
breasts, diseases of the bones, rheumatic and other pains, 
will come on, as symptomatic of the action which would 
have attended the milky secretion. For ever bear it on 
your minds, that nature will not be trifled with ; her 
laws are not to be violated with impunity ; atonement she 
will have for all your irregularities. Your physicians may 
postpone, but your bodies must make the payment at last* 

It is a subject of considerable anxiety among mothers, 
what is the best food for them to take while giving suck. 
I am happy in being able to settle this question with perfect 
certainty ; and I beseech you to remember it. 

I have already told you, that the stomach secretes a li- 
quid to dissolve what we eat, which becomes adapted to the 



220 

nature of the food we take ; a change in diet then neces- 
sarily changes this liquid, and the stomach can never be 
changed, without its affecting other parts of the system. 
The diet then for a woman, is the diet to which she has 
been most accustomed. If she has not been habituated to 
any one, she should commence while giving milk, for at 
least the first three months, until the powers of the babe 
become equal to the change. The diet should not be so 
thin as is generally taken ; it causes the milk to be too wa- 
tery j requiring such large quantities for the child, as to de- 
range its stomach, and incline to gluttony. This effect is 
pretty much as the secretion of urine on drinking freely of 
liquids ; it contains not an eighth of the salts and other 
matter, which it has when secreted without such drink. 
The liquid does not go to the glands, but the glands sym- 
pathise with the watery excitement of the stomach, and 
secrete the xvatery fluid. The proper diet then for mothers 
is one of solids, only a moderate quantity of liquids ; 
never changed for the first three months ; always, when 
to be changed, slowly done. 

It is improper for women to take large quantities of sti- 
mulating drink while giving suck. There will be an abun- 
dant secretion from the stimulus of exercise ; and this is 
the best stimulus. It is because* women giving milk are 
so sedentary while suckling, that there are such determi- 
nations to the breasts, which end in so many disorders of 
the parts. They should take more exercise, by walking 
at this time, than at any other, in order to equalize the 
action of the blood vessels. Among the delicate I would 
recommend the stimulus of any white pure wine, with 
moderate dilution. 



Some women give but small quantities of milk ; in ge- 
neral the difference in quantity is made up in quality. 
The means of increasing this secretion, are, free living, 
great exercise, much handling, and drawing the breats af- 
ter the child has sucked. They should be drawn with a 
strong mouth, fully exerted, particularly when the action 
of the pulse is increased by excessive diet or drink. And 
there can be no doubt of success, especially if a large hot 
poultice be immediately applied for two or three hours. 

When it is designed to suppress the secretion of milk, 
a directly different course should be pursued. Abstemi- 
ous diet, avoiding salt, taking but few drinks, and a daily 
purge, are called for. The whole breasts should be cover- 
ed with a rag wet with a weak, cool solution of sugar of 
lead, to be applied every two or three hours. Sweet oil 
may be substituted at night. When they become painfully 
distended with milk, they should always be slightly drawn, 
merely enough to relieve the distention. 



DISEASES OF LYING-IN WOMEN. 

PAINTINGS. 

The first complaint after confinement, is generally a sense, 
of faintiness. As soon as observed, an examination should 
be made, to ascertain if there be flooding. In this case, 
cold applications, and cool air, are indispensable, and should 
be fully used ; the head kept low, and the womb com- 
pressed with the hand, to make it contract. When there 
is no loss of blood, a glass of wine or toddy should be given 



222 

with gruel. A wide bandage around the belly, drawn 
tolerably tight for an hour or two only, will support and 
compress the parts, and thereby relieve the complaint. 
Sometimes this arises from the falling down of the womb ; 
which points out the propriety of feeling for the womb, in 
the belly. When there is great coldness of the extremi- 
ties, hot applications should be made to them. 

CHILLS. 

When the chills and coldness which women generally 
have after delivery, are excessive, they are to be relieved 
by hot bricks to the feet, wrapping the legs up in hot flan- 
nels, and hot applications to the belly, opposite the stomach. 
Their legs may be rubbed under the bed clothes, with a 
coarse brush. But it is absolutely improper to take stimu- 
lating drinks, as they actually increase the fever which en- 
sues. Hot tea or gruel is the only drink that ought to be 
taken. When the shivering is very violent, it is expedient 
to hold the patient fixed, until they subside. 

AFTER PAINS. 

These pains are generally least distressing at the deliv- 
ery of the first child, and after long tedious labours. They 
arise from the contractions of the womb, to expel clots of 
blood, and the secretion contained in it. Sometimes the 
pains are almost as severe as those of labour. They are 
felt in the lower part of the belly, and sometimes in the 
back, like those of labour. They are usually accompanied 
with the discharge of clots of blood, and frequently are re- 
newed for a day or two, especially when the child is ap- 
plied to the breast. 



223 

When these pains are moderate, they should not be in- 
terfered with. When they are severe, they will be reliev- 
ed by a bladder of hot water on the belly, or hot wet cloths. 
An injection of forty or fifty drops of laudanum in the 
bowels, will generally afford relief: as also half the quan- 
tity swallowed. But this had better be dispensed with, as 
all stimulants are improper ; especially the spices, drams, 
and wines usually given by old women to relieve this com- 
plaint. 

LOCAL INFLAMMATIONS OF THE PARTS. 

When there is great soreness about the belly, acute sen- 
sibility to the touch, it is incumbent on every woman to 
evacuate herself freely immediately, and to foment the bel- 
ly by flannels from hot water and sweet oil, until she can 
get a physician. It is the miserable habit of neglecting 
this course, which causes so many women to have the pu- 
erperal fever. 

Inflammations and suppuration of the external parts of 
generation, are extremely apt to occur after tedious labours. 
The application of sweet oil, or hog's lard, with or without 
suet, also poultices, cold and lead water will speedily relieve 
the parts ; or rather, if they are kept clean and greased, they 
-will relieve themselves. Whenever the sides of the birth- 
place ulcerate, greased lint or rags should be daily applied, 
and stuffed between them, so as to keep their edges apart. 
Women are also very subject to a bearing down of the 
womb, termed its falling down y when describing the dis- 
eases of the womb. To remain lying quietly, repeatedly 
in the day washing the parts, squirting water up the birth- 
place, fomenting with wet cloths when painful ; taking no- 



231 

thing to stimulate the system ; are the prescriptions to be 
attended to. Affections of the stomach, head, and bowels, 
often attend this complaint, and are mistaken for original 
affections, instead of those from sympathy. Dr. Burns says, 
" although rash management on the part of the midwife 
may occasion this complaint, yet it is much oftener the 
fault of the patient herself; getting up too early after de- 
livery or miscarriage. There is another affection which 
may be mistaken for this ; it is a relaxation and protrusion 
of the passage to the womb ; forming a soft swelling at 
the side ; sometimes entirely encircling the opening, at 
others, greatest at one side ; it gives no particular uneasi- 
ness, and disappears on going to bed. The cure is effected 
by washing it with weak solutions of sugar of lead, of 
white vitriol, or of alum. The frequent application of cold 
water alone, often cures. 

The parts about the fundament are very apt to become 
irritated, constituting lesser degrees of the piles. The mo- 
ment pain is felt in these parts, rags, wet with a weak so- 
lution of sugar of lead, should be applied ; a rag wet with 
cold water, will often relieve. When the irritation is con- 
siderable, sweet oil, or fresh hog's lard, on going to sleep, 
will be of service j you should refer to what was said on 
the subject of the piles. Sometimes the irritation about 
the fundament arises from small worms in the lower gut. 
Injections of brine, of sugar and water, or of any irritat- 
ing liquid, will destroy them. 

INFLAMMATION OF THE BREAST. 

The inflammation of the breasts is a source of incalcu- 
lable misery to mothers, and deprivation to children. 



225 

All mothers should have such affections in their view at 
every confinement, in order effectually to guard against 
them. No complaint can be more certainly prevented by 
proper care. 

You must bear in mind, that your systems are in an in- 
flammatory state after delivery, for two or three weeks. 
It is the general fever which produces these local obstruc- 
tions in the breast. The means of prevention, are ; never 
fail, three hours after delivery, to apply a soft, warm poul- 
tice of milk to the nipple and breasts, to favour the dis- 
charge of the first milk. Let the poultice remain from 
two to four hours ; and, if the child do not suck, let some 
person suck a little milk from the breast. Let the 
breast be bathed with sweet oil, if possible to be had, if 
not goose grease, or hog's lard. Never let the diet be 
free, until the secretion of milk be well established ; and 
never let the breasts remain painfully distended with milk ; 
for, in every stage of giving milk, when the breast is full, 
from the slightest cold and fever, inflammation is apt to 
ensue. 

The most important means of lessening the liability of 
the breasts to inflammation, is ; never to have them too 
thickly covered, never fail to wash them every morning in 
cold water as regularly as the face. I dwelt sufficiently on 
the influence of cold water on important parts, while ad- 
vising the daily sitting in a tub of cold water. The whole 
is applicable to the breasts ; most animals have their teats 
exposed to cool air, and they, as the negroes, have but few 
afflictions of them. At first you can wipe them with a 
wet cloth, then lean over a basin filled with water, and let 
one at a time be dipped. Indeed you will find this one of 



226 

the most effectual means of preventing the inflammation of 
the nipple as well as the breast. It will give a tone, a 
hardening' to the parts, which, exclusive of the cleanliness 
of the habit, will be extremely advantageous. You find 
your hands and face improved by this cold washing, and 
why will you withhold it from your breasts ? 

Lastly, the moment there is the least appearance of in- 
flammation, apply a solution of sugar of lead (a tea-spoon- 
ful of lead to a pint of water.) Keep a rag wet with this 
constantly on and around it, until the inflammation disap- 
pears. If the inflammation increases, by all means apply 
leeches to the part, take a strong purge, and refrain from 
taking more than half of your ordinary diet, until the cure 
be complete. I have seen such excess of agony from 
neglecting these precautions, that I feel a strong soli- 
citude to enforce the observance by every woman with 
an infant at her breast. I am positive, that no woman 
will have an abcess, (called boil,) on her breast, who will 
duly attend from the beginning. 

If the inflammation be not dispersed, its extent will be 
greatly reduced ; and this is an important point. The old 
practice of hot poulticing the lump should never be done ; 
nor is rubbing the breast with the hand proper. Nothing 
that gives pain should be applied. When it is ascertained 
that the boil will suppurate, it is best to discontinue the 
lead, and to apply bread and milk poultice. When the 
matter is fully formed, it ought, at its lower depending 
part, to have a small puncture, very small, for the gradual 
escape of the matter without admitting air. As soon as 
opened, a little lard may be applied to the edges, then the 



227 

solution of lead is to be continued, by covering with a wet 
rag as at first, in order to prevent a return. 

The question of drawing the nipples, when the breasts 
are in a state of inflammation, has been differently decided 
by physicians, one in favour, the other opposed. The pro- 
priety, however, of the prescription, depends on the treat- 
ment of the patient. If it be determined, that the wo- 
man shall eat and do every thing she can to increase the 
inflammation of the system, drawing the breast is impro- 
per, for it only brings on an additional determination to the 
part, tending to increase the disease. But if she refrain 
from inflaming her system, by exercise, diet, and drinks ; 
if the breast be kept particularly cool, a rag wet with su- 
gar of lead to the outside, (not on the nipple, where it 
may get on the child's mouth,) then moderately drawing 
the breasts repeatedly in the day, is a most powerful re- 
medy in relieving the inflammation. 

SORE NIPPLES. 

This is a complaint to which most women are subject ; 
and as it is extremely distressing, is worthy of serious at- 
tention, as well for the prevention as cure. 

The frequency of the diseases of the nipple, unquestion- 
ably arise from the improper manner in which they are 
universally treated. Mothers expecting their daughters 
to become mothers, should pay particular attention to their 
manner of binding their breasts. Compression continued, 
will cause the absorption even of our limbs to be almost 
completely reduced : no wonder then, that the tight ban- 



2,28 

dages around the breast, reduce its size, and destroy the 
nipple. No females but women have their teats com- 
pressed* 

In order to guard against sore nipples, they are not to 
be compressed, and are to be washed daily in cold water, 
as regularly as the breast. In those cases where the nip- 
ple has sunk, or been pressed in, wearing rings of wax 
over it, so that the nipple may protrude or pass through, 
or wearing the glasses called nipple glasses, during preg- 
nancy, to promote the lengthening of the nipple is proper. 
Washing them in brandy and water, has also been recom- 
mended for hardening them. 

When the nipple becomes sore, it is first necessary to 
guard it against the rubbing of the clothes, by wearing, 
during the day, a wax cup over it, made so as to receive 
the nipple. Those made of lead are better than of wax. 
Washing them with a weak solution of sugar of lead in the 
beginning, is of great efficacy. Washing with a solution 
of alum in brandy, with spirits, borax in water, a solution 
of nut galls, laudanum and water, opium in water, port 
wine, and such articles, are to be tried occasionally, for a 
few days at a time. Dr. Bard says, " simply keeping a 
linen cloth constantly wet with rum, over the nipple, will 
frequently do more than either ; but then it must be kept 
constantly wet. Sometimes precipitate ointment, on slips 
of rags, and applied, has done good." It has been found 
of service to procure the teat of a heifer, (let her be dead 
before it is cut off,) and fastening it to the nipple of the 
mother, and a metallic or wooden pipe to the other end for 
the child to suck. The best application to the sensible 



$29 

parts or sores around the nipple, is lunar caustic. The 
caustic is to be applied to each little ulceration, as is done 
for warts. Let the parts be tolerably dry, the end of the 
caustic merely moist, (not a drop pending to it,) and there 
will be but little pain ; the cure is certain. The milk can 
be drawn on covering the nipple with a rag, as used for 
straining milk, and given to the child : as soon as the scabs 
come off, which will be in a day or two, the child may be 
applied to the breast. To preserve the parts clean and 
cool, and to be as little moved as possible, are important 
points. 

^IILK FEVER. 

Between the second and third days after delivery, the 
breasts become distended, from the milk secreted in them, 
and the discharges from the womb diminish. This is 
attended with some heat, thirst, head-ache and fever. 
This fever is partly owing to the disturbance, which, to a 
certain degree, constantly takes place in the system, when- 
ever a new process is established ; and partly to the swell- 
ing and irritation of the breasts themselves. The degree 
of the action will be greatly lessened by following the ad- 
vice of early applying a soft poultice to the breast, to favour 
the escape of the first secretion ; then never failing to ap- 
ply the child to the breast, within from six to twelve hours. 
Rubbing the breast with sweet oil, goose grease, or fresh 
hog's lard, will tend to prevent, as also taking some laxa- 
tive, and confining to a low diet. 

When the fever takes place, the treatment is very sim- 
ple. Give any warm drink, as lemonade, gruel, or weak 



230 

tea; allow the free entrance of pure air : if the feet be cold in 
the beginning, apply hot flannels. During the whole fever, 
the above drinks may be taken. In general, no other pre- 
scriptions are requisite ; but if the fever be high, the breasts 
painful, a purgative of salts should be given, a slight bleed- 
ing, then two grains of tartar emetic in half a pint of water, 
to be taken one eighth every hour, till perspiration is ex- 
cited. No heating articles are to be used ; when the fever 
is over, the recovery is rapid, to be promoted by sitting 
up, and taking the food before prescribed, 

PUERPERAL FEVER. 

The puerperal is commonly called the child-bed fever. 
When it comes on, it is generally in the first week after 
delivery, about the third or fourth day. It begins with a 
shivering like the cold fit of an ague, and like it, is, suc- 
ceeded by great and burning heat of the -whole body, 
thirst, flushing in the face, pains in the head and back, 
sickness at stomach, especially with great sensibility of the 
belly, so much sometimes, that the weight of the bed- 
clothes is oppressive ; the belly feels full, sometimes there 
is great pain and a looseness. Sometimes the disease 
comes on without a shivering fit, beginning impercepti- 
bly with languor, faintness, sickness, frequent vomiting, 
sweating, and looseness. It is distinguished from the milk 
fever, by the shivering, and by the breasts, which do not 
swell and become hard and painful as in the milk fever. . 

This disease may be defined a general fever, partaking 
of the character of the prevailing fevers of the place 
where it appears, attended by inflammation of the womb, 



231 

and the adjoining parts concerned during delivery. Hence 
in wards of hospitals, in confined rooms, in unhealthy spots, 
it often appears of a low, nervous character ; and in the 
neighbourhood it may be inflammatory. It is prevented 
by adhering to the directions given for the conduct of wo- 
men while lying-in ; most of all, by keeping the bowels 
open, the birth-place clean, and pure air. 

During the cold stage of the fever, hot applications are 
to be made to the feet. When the hot stage comes on, 
cool drinks are proper. The patient must be blooded and 
freely purged with calomel, followed by a dose of salts ; 
a solution of tartar emetic, ten grains to a pint of water, 
and one or two spoonfuls taken every hour or two, so as 
to keep up a constant sickness of stomach, will afford the 
best means of relieving the fever. Antimonial wine may 
be substituted, or any preparation of antimony ; but you 
may rely upon it, that keeping up the sickness just so long- 
as the fever lasts, is the only certain method of cure ; you 
should inject in larger quantities in the bowels, if the 
stomach do not retain it. 

The belly is to be well covered with sweet oil ; occa- 
sionally warm cloths, wrung out from hot water, are pro- 
per in allaying the irritation. As I never knew good 
sweet oil to be applied to or near an inflamed part, with- 
out lessening the irritation, I would not only have it ap- 
plied on the belly, hut injected up the bowels and birth- 
place, and detained there as long as possible. 

When the action of the system is reduced, or when the 
disease assumes the low nervous character, then an oppo 



232 

site course is proper ; wine bark, toddy, nourishing diet, 
are requisite, in such portions as will keep up the action 
of the system. But I suppose you will be s\jre to have a 
physician to prescribe in these cases. 

MILIARY FEVER. 

I extract the following from Doctor Moss, as his testi- 
mony may have the more weight in securing your atten- 
tion. 

" A miliary fever is what'lying-in women are known to 
be sometimes liable to ; and is known and distinguished by 
an irruption resembling a rash, coming out commonly first 
upon the neck and breast, afterward upon the other parte 
of the body, and seldom or never upon the face : it gene- 
rally appears the thickest upon those parts which are kept 
the warmest and closest covered. 

" The eruption, upon its first coming out, is red; but to- 
wards the second or third day it becomes white ; and soon 
after goes off with a dry scurf. The complaint does not 
however terminate here, as it is immediately succeeded 
by another rash or eruption, which proceeds, and goes off, 
in the same manner ; and that, sometimes, successively 
and repeatedly. 

" The time of its first appearing is uncertain : it seldom 
comes before the end of the first week ; and may happen 
afterward at any other period of the confinement to the 
bed particularly. It is attended with a sense of weakness, 
and a dejection and depression of spirits. 



233 

" This fever, and these appearances, are entirely occa- 
sioned by much warmth, warm and heating things, and 
more especially, by much and long continued sweating in 
bed, as there is every reason to suppose it never happens 
without, and except in consequence of much sweating, 
The means for preventing it therefore are very clear and 
obvious ; and if the method and directions at, and from 
the time of delivery, and during lying-in, are properly 
attended to, it may always be with great certainty pre- 
vented, and never be feared or apprehended. 

" With respect to the treatment and cure of the miliary 
fever, when it does happen, it may be observed, in general 
terms, that the same means which will prevent it, are 
also the likeliest and best suited to remove and cure it. 
The medicines, and other medical treatment of it, cannot, 
with any prospect of advantage be here given ; however, 
the following directions may, so far, be safely observed 
and attended to. Every means that can heat the patient 
must be cautiously avoided. The room must be made 
cool, by removing the fire, or setting open the door, and 
even a window if needful. The bed-curtains must be un- 
drawn, and the additional quantity of bed-clothes, if any 
there be, be removed ; all which must be dene gradually. 
Whatever she takes as food or drink, must be cool, and 
without spices, wine, or spirits of any kind. If she is cos- 
tive, a stool or two, and not more, must be procured by a 
clyster, some laxative, infusion of senna, or castor oil : 
much of a looseness will be injurious. 

" As soon as, by these means, the heat and sweating are 
checked and abated, she must be raised up and supported 



234 

in bed, and, with the assistance of a bed-chair, she will be 
able to sit up in bed ; and which she may do once, twice, 
or oftener in the day ; observing that she be not too much 
covered up, and muffled in the bed-clothes, &c. and that 
she has her hands and arms out of bed, which will be a 
means of putting an entire stop to the sweating, and, of 
course, of removing the disease. She ought, as soon as 
she is thought able of bearing the fatigue of it, to be got 
out of bed once a day, which will be an effectual means of 
removing any remains of the complaint, and also of pre- 
venting a return of it. The notion that is commonly en- 
tertained of the propriety of keeping up a heat and sweat- 
ing, by way of forcing out the rash or eruption, is very er- 
roneous, as the heat and sweating are the sole causes of 
the rash, and consequently the removal of them must be 
the most sure means of removing the complaint : and 
except the sweating is checked, and even entirely stopped 
(which may be done with safety, by degrees,) all other at- 
tempts to remove the disorder will be vain and fruidess. 
It is well known that long continued sweating will alone 
produce a rash at any other time, and upon any other oc- 
casion. 

" This complaint is justly dreaded, as it has proved 
fatal, in this situation, when in the extreme ; although a 
slight attack of it may be got over without danger. It was 
very common, when sweating, and long confinement in 
bed, and heating things were in vogue ; and is much less 
so since the cool treatment has been introduced. Those 
of weak and delicate habits seem more liable to this com- 
plaint than the strong and healthy," 



233 



COMMON FEVERS. 



There is a fever common to many women in child-bed^ 
called a weed. But there is no foundation for particu- 
lar names for any of the fevers to which such are sub- 
ject, excepting the milk fever. As before remarked, in 
this state their systems are very susceptible of febrile ac- 
tion. 

The directions for treating any kind of chill and fevers, 
are the same as those offered for the puerperal or child-bed 
fever. In the cold stage, apply hot articles, slightly burn- 
ing, to the extremities ; in the warm or hot stage of the 
fever, evacuate and keep cool. A good purge in the be- 
ginning; and any preparation of 'antimony -, taken in small 
doses, to keep up for hours, and sometimes a few days con- 
stant sickness at the stomach, is the sum of all the improve- 
ments made in treating persons under fever. I would 
strongly urge to all females labouring under any feverish; 
symptoms, to resort to these antimonials in preference to 
all the trash which has been offered, as sudorifics^ cooling 
powders, and the like nonsense. 

SWELLED LEG. 

Chitd-bed women are liable to a very peculiar disease, of 
which a swelling of the lower extremities, preceded and 
accompanied by great pain, difficulty in moving, are the 
most remarkable symptoms ; not appearing connected with 
any peculiarity of constitution or preceding complaint, nor 
the kind of preceding labour, or on the treatment before or 



236 

after child-birth. It occurs at any period from the nr*t or 
second day, to two or three weeks after delivery ; it is 
preceded by general uneasiness, lowness of spirits, slight 
pains about the womb, with a discharge from it peculiarly 
offensive. These symptoms seldom command much atten- 
tion, until the patient is seized with pain on the inside of 
the limb, commonly about the calf of the leg, which soon 
extends from the heel to the groin, along the course of the 
vessels called absorbents. The limb soon after begins to 
swell ; the soreness extends all over it, so that it cannot 
bear the slightest touch, and every attempt to move gives 
exquisite pain ; the skin becomes glossy and pale, the 
countenance is expressive of great anguish and dejection, 
the pulse is quick, the heat of the skin increased, the tongue 
white, and the urine muddy. 

These symptoms strongly mark the absorption of some 
acrid, irritating matter ; and no doubt it is taken from the 
womb. The prevention must depend on cleansing the 
birth-place, injecting water with such force as to enter and 
cleanse the womb. 

The cure of this complaint is often tedious ; sometimes 
the other leg takes on the disease, as the first subsides. 
Gentle evacuations, keeping the bowels open, bathing the 
limb in sweet oil, and in oil and laudanum in equal parts, 
is always proper. Laudanum may be taken to procure 
rest, when the pain is violent. Dr. Hosack of New- York, 
and other physicians of eminence, recommend strongly, 
taking about two grains of calomel mixed up with the like 
quantity of squills, made into a pill, to be taken every night, 
and morning also, if there be no excessive purging. The 



237 

moment this disease begins, I would recommend the 
immediate cleansing of the birth-place, and using the 
strongest syringe to inject up water : a table spoonful 
of the finest powdered charcoal mixed up with sweet oil, 
should, after the washing, be also injected up, and retained 
for some time by a plug or the hand. This will prevent 
the discharge from becoming so offensive, and lessen the 
irritability of the part, inclining it to the absorption. 

MANIA OR MADNESS. 

The peculiar connection between the womb and the 
head, was before stated ; in consequence of this connection, 
women after delivery are very subject to head-aches and 
to madness. 

The derangement of women after labour, does not re- 
quire the evacuations used for this disease on other occa- 
sions. Moderate bleeding is proper, if the pulse be active, 
with slight purging. It is advisable to lose the blood by 
frequent cupping : issues in the back of the neck are of 
more use than blisters in this disease. Frequent vomits 
are very proper. Great attention should be paid to re- 
storing the womb to its natural action, menstruation. For 
this object, the purges should be of aloes ; sitting in hot 
water, injecting a little brandy and water up the birth- 
place ; blisters on the thighs, or one on the perineum, will 
be found of powerful efficacy in restoring the menses. 

Women in this state should be treated with perfect gen= 
tleness ; thwarted in nothing not injurious. Travelling, 
change of air, a»d the salt bath, will all tend to restore the 
intellect, as well as the body. 

Hh 



339 
LETTER X. 



Treatment of children after birth— navel— washings 
dress-— applying to the breast — their first diet — -that of 
the mother — rocking — sleeping— to have the mother's 
zvarmth, without danger of suffocation — evacuation of 
their bowels — air for respiration-— clothing — exercise—* 
simplicity of diet — objections to compounds as cake- 
weaning — teething of children— lancing gums recom> 
mended universally* 

The next subject that presents itself as of great import- 
ance for all women to understand and attend to, is the 
proper treatment of their children, to be directed by them- 
selves, not by ignorant nurses. The variety of plans 
which have been adopted and recommended, would fill a 
volume. Even the stupid would be astonished to observe 
some kind of treatment, different from that which they 
follow, probably of not worse tendency than their own 
usages. Every midwife and every family appear to have 
some peculiarity in the treatment of children. Surely the 
whole of them will have to account for the injuries they 
have done to babes, if we have ever to account for fol- 
lies which might have been avoided by the exercise of our 
natural sense. As an example of such follies, in one of 
the most intelligent families I have ever seen, the mid- 
wife was allowed, at every birth, on first dressing the child, 
to hold it up by the heels, and give it a sha£e ! then a mo- 



240 

derate dose of brandy and water : this stimulus, aided 
with nutmeg, was poured down the throat ! Indeed, al- 
most in every house, I have been struck with the infatua- 
tion that prevails on such occasions ; something must be 
given ! every thing appearing, but good common sense. 
Because the business of generation seems so mysterious, 
something extraordinary is supposed to exist in every de- 
partment ! To break the spell, to put down the prepos- 
terous boast of experience among old nurses, and some 
mothers ; to teach the bystanders, that the bodies of the 
little babes are subject to the same laws as their own, pre- 
sents as an important point, from the singular infatuation 
prevailing on the subject. If the little innocents could 
speak, they would tell you, they knew no difference be- 
tween being disordered and destroyed by intended kind- 
ness, or by intended neglect. 

In the hope, that you will yield to reason ; with the 
earnest entreaty, that, for the sake of humanity, you will 
conform to the course pointed out and confirmed by the 
most successful practice of the greatest physicians, I pro 
ceed to state the directions for the treatment of children 
which should govern every woman. 

After the child is separated from the mother, the utmost 
care is to be taken to prevent its receiving colds. These 
colds affect it most seriously, producing inflammations 
of a destructive kind, in the lungs and bowels. In order 
to guard against them, the child should be received in a 
warm flannel, having an opening to breathe, and kept in a 
warm place, where no cool air can have access, until warm 
water is procured for washing it. Never use cold water 



241 

for the purpose, and nothing but warm water. By gently 
washing it in warm water, the matter adhering to the skin 
will come off, if not the first, the succeeding day. After 
it is kept in the water a few minutes, undergoing this 
gentle washing, it is to have a linen rag put on its navel, 
a burnt rag, or any charcoal might be first applied to les- 
sen the offensive smell of the part that comes off. Gene- 
rally there is a sore, made by the nutmeg and other trash 
foolishly applied ; there will be none, if the parts are 
dressed with simple sweet oil, or hog's lard, after the se- 
paration of the cord, which takes place about the sixth 
day ; no irritating matter, nothing but something mild is 
wanted to exclude the air from the surface. After a linen 
rag is applied to the navel, a band is to be applied around 
the belly, not tight by any means, as compression of the 
belly will be injurious* The next object is, to dress the 
child : no clout is necessary to be put on ; the child can't 
turn, and simply putting a cloth under is sufficient for a 
month ; its clothes should be of linen ; no pins to secure 
them, but strings ; never allow its limbs to be confined : 
the more it can use every part, the sooner will it 
strengthen. 

The child being dressed, it requires nothing more than 
to be laid down, level, to repose quietly. From the fifth 
to the tenth hour after birth it should always be applied to 
the breast of the mother. It wants nothing else ; the milk 
is its physic and its best nourishment. You will observe 
the redness of the skin, sometimes blisters, and extreme 
irritability in every part. These are symptoms of its inflam- 
matory state ; and these, exclusive of experience, pro- 
cfaim the folly of giving it other stimulants, drinks, or 



24& 

mixtures, to add Lo the too much excited actions of its bo- 
dy. It wants nothing but its mother's milk, for which it- 
should be applied to the breast in the time above directed* 
The first discharge from the breast will, in all probability, 
open its bowels in sufficient time. If the bowels are not 
opened the second day, pushing gently half an inch up the 
fundament, a small quill covered with an oiled rag, will 
produce the evacuation ; in case of failure, a tea-spoonful 
of sweet oil poured down its throat, to be repeated in three 
hours, if the first be not successful ; lastly, for continued 
failure, a tea-spoonful of castor-oil, or a little manna, might 
be given on the third day, I never knew . the introduc- 
tion of the pipe, as above advised, to fail in producing an 
evacuation. It is always to be preferred to giving medi- 
cine. 

It will not be necessary to refer to the medical part, 
the treatment of the small blisters, swellings, and inflam- 
mations, which are soapt to appear on the skin, and parts 
compressed at birth. The cure is to be effected, by not 
touching them ; some prefer puncturing the blister with a 
sharp needle, so as to let out the water, without letting 
in air ; a cold, wet rag, applied for a few minutes, will 
expedite the dispersion of the swelling^. For other com- 
plaints I refer to the next letter. 

The rules for nourishing children are, never for sixty or 
seventy days, give any thing but the mother's milk ; in the 
beginning give the breast every three or four hours. 
Some have urged to begin with establishing hours for 
this supply ; but they mistake. The habit is best acquired 
weeks after. In the womb its body was slowly and con- 



243 

stantly nourished ; and we should imitate, by having in its 
stomach, always a little, never much at a time. I suppose 
the means I have recommended for exciting the breasts, 
will have been used to insure the supply of milk. But if 
accidental causes should render it impossible for the mo- 
ther to give milk, then, as the lesser evil, some woman 
should be procured who can yield the supply. Giving in- 
fants other food, has done incredible mischief. No other 
animal requires aught but the mother's milk ; yet there is 
scarcely a midwife or nurse in the country, who is not for 
pouring down the child's throat, soon after its birth, some 
of their mixtures. There is not one of these compounds 
that does good. They pretend they give very little ; then 
the very little can be of no service ; never yield a fiftieth 
part of the nourishment taken away by its acting as irri- 
tating substances in the bowels. Instead of giving up the 
early treatment of children to such attendants, there is 
stronger reason then than in subsequent advanced stages, 
for the mothers and friends to exert all their senses on the 
subject. Follow nature ; I cannot impress on you too 
much. Nature never intended, that for your child's ac- 
commodation at birth, a ship should have to sail to the 
East Indies for nutmegs, and another to the West Indies 
for sugar, to make the almost universal doses given to 
children. Nature could hardly have provided against 
such abominable outrage on its laws : to add to this, sugar 
and water, and nutmeg, the intoxicating liquors, is shame- 
ful in the extreme. If there be not enough milk in the 
mother's breast, and another nurse cannot be had, then 
give the like — cow's milk newly drawn, mixed one third 
with warm water, with very little if any sugar. After 
sixty or seventy days at least, the child may then properly 



have its diet changed ; first, it is best for some other wo- 
man occasionally to suckle it, then the mixture above 
mentioned, and then milk alone, until all the common arti- 
cles of our diet may be administered. 

The periods of feeding the child should be regulated about 
this time ; beginning to let it suck very late at night and 
early in the morning. After a week or two, the breasts 
may very well be withheld during the night, and by de- 
grees reducing the times of feeding to four or five times a 
day. It is so important that I would impress it an hundred 
times — most gradually make every change in the child's 
diet. Begin with the mildest articles, and but in small 
quantities ; the article you begin with, persevere in its use, 
unless powerful reasons prevent, until the child is habitu- 
ated to it. I repeat the remark, one good healthy article 
is nearly as good as another. Boiled milk diluted and 
bread, or arrow root, or sago, are excellent articles to 
commence with : weeks after soups and boiled meats may 
be substituted. 

On the subject of raising children without the breast, 
Dr. Burns says, " a mixture of cow's milk, water and 
sugar, has been used as a substitute for breast milk. 
But more advantage will be derived, by adding to cow's 
milk, a third part of new made whey, (not made by wine,) 
with a sixth part of sweet cream and a little sugar. Whey, 
with the addition of cream, and very little sugar, without 
milk, may also be employed." Children have been reared 
tolerably well on these mixtures, without the breast, though 
never as well without as with it ; which is a strong reason 
why wet nurses should be got if possible. Dr. Moss says, 



21j 

that an excellent substitute for breast milk, is the milk of 
a cow, (the cow should never be changed,) drawn when- 
ever wanted, and mixed with one third warm water, not 
to be boiled. The addition of sugar is not needed, better 
without any, but if any, let it be but little, as the stimulus 
of the sugar is too strong for the bowels, and often pro- 
duces disease. It is more incumbent not to change the 
diet of children brought up at the spoon, than those at the 
breast, as their bowels are very irritable. Whenever their 
stools become very offensive, you may rely upon it that 
they are diseased ; in nine times out of ten, from some- 
thing defective in their diet, often from quantity as quality. 
Whenever any diet disagrees with them, it should be dis- 
continued, and a physician consulted for directions. 

In feeding with the spoon, care should be taken not to 
feed until the child ceases to eat, a little often is better than 
much at once; the jaws tire while sucking, but not so 
much in taking from the spoon. 

"With respect to the time of moving the child, Dr. Moss 
remarks, that warmth and rest are indispensably necessary 
for infants at an early age. " In the first week, it should not 
be carried out of the room ; not till the end of the second 
week should it be carried out; and then only to adjoining 
apartments. About this time the child, if it do not appear 
disagreeable to it, may have its skin rubbed gently with 
the hand, its legs and arms stretched ; it may be handled 
once or twice a dav, for a little time, on the nurse's knee, 
near the fire. During the third week, the time of the 
child's being up and out of bed may be lengthened ; and 
after this its other exercises are to be conducted by degrees. 

t i 



£46 

In the beginning, great caution should be observed in car- 
rying the child into strong light, and a damp air." 

Many women feel considerable anxiety on the subject 
of the influence of their diet, on their children's health, 
especially in early infancy. They fancy that the physic they 
take enters in their milk, and operates on the child as on 
themselves ; but this is a mistake ; and it is folly in a mo- 
ther to swallow medicines for the purpose of affecting the 
child. Now it is a truth, that whatever affects the stomach 
of the mother, affects her milk ; and whenever changes in 
the milk are made, they affect the child, not by any means, 
however, always in the manner they operate on the mother. 
If the mother change her diet, or drink, or take any medi- 
cine, or get in a violent rage, or have a fever, unless the 
child be unusually healthy, it will be affected by the altera- 
tion wrought in the milk : generally purging will be ex- 
cited, just as it will be, if any foreign, irritating substance 
is given to the child. From this an important inference 
should be drawn by mothers : they should learn to adhere 
to one diet, to be regular in their habits, to preserve their 
tempers while their children are at the breast ; at least un- 
til their constitutions are well improved. Those who have 
delicate children, should of course pay the more attention 
to this subject. I will only add, the best milk is given by 
those females who preserve their health by simple diet, 
taking only the stimulus of exercise and pure air. 

There is no treatment of children found so certainly 
beneficial, as washing them all over every morning in a 
tub of warm water, from the day of their birth, till they 
have passed two years of age. It is a luxury every wo- 



24? 

man can afford for her child, indeed they will find econo- 
my in its use. The free motion of \tr, limbs in water, 
contributes to its health. The circulation of its system 
is greater than ours, and therefore in proportion it has 
more excretions. These excretions are more apt to become 
acrid and irritate, than those of grown persons. It is there- 
fore most important to immerse them daily in warm water, 
that the surface of their bodies may be kept clean. More- 
over, the warm water tends to equalize the action of all 
parts of their systems, on which equalization depends their 
health. I never knew children subject to irruptions, nor 
one tenth so sickly, when daily made to sit, immersed from 
neck to toe, in warm water, as others under the same cir- 
cumstance excepting the washing. If you be a fond mo- 
ther, half of either reason I have given, will induce you 
to attend to the prescription. You will be delighted at 
witnessing the pleasure the child shows in the bath, and 
much more at the consequent exemption from disease. If 
you be a friend to humanity, most earnestly entreat every 
mother, the poor and the ignorant, to adopt the practice ; 
remind them of the facility of warming water with hot 
stones or irons, and many will be the lives saved. No- 
thing but severe illness, should ever postpone the daily 
operation. 

Some persons have recommended bathing the children 
in cold water, but the shock is too severe ; it has been 
the death of many. Nevertheless many have improved 
under its operation. I know that the warm bath is best, 
and I cannot see the least reason for using the cold, ex- 
cepting the incorrigible laziness of those who may ne» 
gleet to warm the water. The advantages of a momentary 



248 

shock to the skin, are abundantly derived from exposure to 
cool air, during the wiping. The astonishing improve- 
ment I have seen so many interesting little children de- 
rive from its introduction, for which important practice, 
much is due to the zeal and benevolence of Doctor Bu- 
chan, that I do most earnestly beseech every mother to let 
hereafter a tub of warm water be the first article, brought 
to her children every morning. 

The question of the propriety of rocking children in 
cradles, has been considerably discussed ; many doctors 
urging that the rolling motion stupefies ; all nurses urging 
the great convenience of the practice. I am certain, that 
the gentle rocking of a cradle, at a proper time, will not 
be injurious. It should always be most gentle, never al- 
lowed by its violence to drown the cries of the child ; ne- 
ver to be done when the child is diseased. It is indispens- 
able for the cure of children's complaints, as well as for cur 
own, that they should have rest. When they cry from the 
pains of disorders, rocking them is excessively injurious ; 
and unless the nurse is cautioned and bound not to rock a 
child crying from pain, there had better be no cradles. 
But these cradles probably never did as much harm 
as shaking the child on the knee, in the way that is so 
unirersal, even in the earliest days of infancy. The 
agitation, most certainly in the state in which the 
brain then is, must have aided in impairing the facul- 
ties of so many. An invariable rule should be with mo- 
thers, never to let a child cry without examining and turn- 
ing it over to rest on another part. 

The next subject is, the proper place for children to 



£49 

sleep in cold seasons. There is a strong feeling to take 
the child in the bed, although many have been destroyed 
by the intended kindness. Yet I will assert, that not one 
has lost its life by the practice, for five that have died by 
the diseases brought on by the coldness and dampness of 
the cradle. There can be no doubt, that a great cause of 
the fatality among children, is their suffering while in the 
cradle alone. We, in our beds, frequently are unable to 
preserve our warmth ; and no wonder the extremities of 
children are so often found cold. All mothers in a natu- 
ral state sleep with their young ; the heat of their bodies 
appears essential for keeping up that of their offspring. 
Excepting among hogs, I never heard of their being suf- 
focated by the bodies of their parents ; and why should 
not women be able to guard against such a misfortune ? 
A variety of expedients could be adopted to have the 
warmth of the mother, without endangering the life of the 
child. The most simple, practicable plan, which presents 
itself to my mind, is, to have a small plank, but little 
larger than the child, its edges surrounded with a few pegs, 
eight or ten inches high, and the little bed to be put in it. 
Any contrivance may be made to prevent the turning over 
to the mother j the pegs will prevent her turning over on 
it. Those who can afford it, can have the contrivance 
made of as fine materials as they please. The expedient 
will answer for the rich and poor, the mistress and the 
slave ; the necessary expense not being ten cents, I would 
earnestly entreat every mother desirous of giving comfort 
to her child, to adopt the plan. It will save children from 
many diseases, as well as pains ; and it will be a conveni- 
ence to mothers to have them so near, for the purpose of 
giving the breast, and applying clean clothes. 



250 

Next I have to request your attention to the daily eva- 
cuation of your children's bowels. If there be no impro- 
per cramming of the child, no sickness, once or twice every 
day, at stated hours, will be sufficient. The advantages 
derived from the cleanliness of the habit, should induce 
every nurse to attend to it. It will supersede the use of 
the clout in almost every case : a great relief to mother >nd 
child. The simplicity of the modes of bringing on the 
habit, is such, that I feel almost tempted to advise giving 
a grain or two of some powder along with it, that you might 
think the dose did the business. But I shall rely on your 
better sense. The means of effecting this regularity of 
habit in the child, are precisely the same as in our own 
case. Turn up its posteriors to cold air every day at the 
same hour, let nothing prevent, if necessary twice a day, 
morning and night, at first introduce an oiled rag around 
a small quill ; some months after a piece of soap may be 
substituted ; keep it there till the evacuation is made. Af- 
ter a little perseverance, (if you will not forget once or 
twice, and let the habit be lost) the child will daily dis- 
charge its excrement at the same hour. You may rely 
upon the success of this treatment in every case, and at all 
times, except when disease is existing. It will greatly con- 
tribute to the health of the child, by preventing the reten- 
tion of offensive matter in its bowels, which it sometimes 
forgets to evacuate. Moreover, the children are often 
afraid to evacuate, because, being great observers of the 
countenance, they see the displeasure and uneasy feelings 
excited frequently at the ill-timed deposit. They retain 
till they can retain no longer, and often show sorrow, not at 
the bad habit disordering their delicate bodies, but that at 



251 

last they are obliged to evacuate* It is the nurse, not the 
child, that in all cases should be condemned. 

I have now to urge for your consideration, the proper 
use of air for children. They, in proportion to their 
bodies, require more and purer air than older persons. A 
confined air is more pestiferous to them than the most fatal 
epidemics. The difference in the deaths and diseases of 
town and country children, establish this beyond doubt. 
Probably an occasional breathing of a pure atmosphere, is 
more injurious than habitual confinement to one that is de- 
fective. Children in very tight houses are never so healthy 
as those in open buildings ; their diseases are mork violent; 
they feel every change of weather. It is equally remarka- 
ble, that although they be more healthy in houses of loose 
joints, in which the air can penetrate, than in those that 
more effectually exclude the air, they never do well, ex- 
posed to cold and currents of wind. They require an. 
abundance of pure air, with their bodies to be kept warm. 
Indeed it seems incomprehensible, how so many children 
could have survived the confinement to the air of close 
rooms, corrupted by their parents, companions, and ser» 
vants, a crowd which may frequently be found in the rooms 
of some very wealthy persons, ridiculously afraid to trust 
their children out of their bed-rooms. All parents should 
bear in mind, that their children cannot enjoy perfect 
health, without having good, wholesome air for their lungs, 
and warm clothing for their bodies. As a child requires 
almost as much air as an adult, there should be never more 
than three to sleep in a room of less than twelve feet sqoare, 
with a door, chimney, and loose jointed window, 



%5Z 

Warm clothing in cold weather, is nearly as essential 
for the health of children as fresh air : comfortable, not 
oppressive clothing. Let their clothes be changed to suit, 
not only the varying seasons, but the changes in the day, in 
spring and fall. It is at these times they are most subject 
to disease, therefore clothing to suit the day is almost 
more essential than in the coldest seasons. The fantastic 
manner in which many mothers dress their children — 
arms and breasts exposed, in cold seasons, betrays as 
much want of sense, as ridiculous vanity. This excessive 
folly is sometimes defended, with the pretence of harden- 
ing their children. Just as the old generals prepared their 
soldiers for fatigues they might never require, killed about 
the half in hardening. There can be but little doubt, that 
a greater number of children have been sacrificed to such 
schemes of hardening. Better commanders now reserve 
their men until the time comes for exposure, and so should 
our better mothers do. You will misunderstand me, if you 
infer that I wish parents to bring up their children with 
oppressive care snd kindness ; destroying them with daily 
confinement to close rooms, only taking exercise by rules, 
and with covering enough to weigh them down. There is 
a medium in all things, to be settled by exercising com- 
mon sense, without a bias to any particular system. It is 
by this that we may all ascertain the best method for rear- 
ing children, neither with excessive care or neglect. Free 
exercise in open air, with comfortable clothing for all parts 
of the body ; a frequent, but not a long indulgence in 
the plays of childhood, while the weather is bad, are 
outlines of management, which all of sound mind must 
approve. We must not deny the propriety of the course, 
if, in a few cases, we see exceptions to its success. Ten- 



853 

dencies to disease are sometimes produced by causes very 
likely to escape our observation, A too confined or crowd* 
ed room to sleep in, eating too much of an unusual 
food, for example, have frequently produced the com- 
plaint, that the over careful have ascribed to their children's 
exposure. Exposure to rains, and more especially ex- 
posure to a hot sun, have had great influence in making so 
many excessively particular about their offspring. They 
restrain the proper playful pursuits of children, because 
other children have suffered ; and often from what the 
beasts of the field take excessive care to guard against, 
that is, exposure to rains, and most to a summer's sun, 
That a child in our country, in the months of June, July, 
August, and September, could survive two hours exposure 
to the rays of the sun, which so frequently kill the most 
vigorous men in a few hours, is to me unaccountable ; 
and I would not believe that they do it frequently without 
perceptible injury, but that I see they do escape. Rely 
not, affectionate mothers, on such escapes ! Keep your 
children from exposure to rains, and particularly a hot 
sun, as you would from a raging fire, or pestilential atmo- 
sphere ; often warn them of the dangers in the beginning, 
and they will habitually shun them : Let all of them play as 
much as they desire in shades, uncontrolled, with cloth- 
ing suitable for the day, and with pure air for their respi- 
ration ; and by such means you will save^miliions of your 
offspring from premature disease and death. 

Another important point I would press parents to ob- 
serve, is, a never varying simplicity of diet for their 
children, at least in the early *cages ©f life, aided by great 
regularity in eating, and indeed in all other habits. The 

k k 



251 

numerous specimens we daily see of distempered, distort- 
ed people, owe their existence to parents disregarding such 
important rules. Strange as it may appear, 'tis selfishness, 
'tis extreme of weakness, that has led to these pernicious 
practices to the contrary. Children are perpetually in- 
clined to be doing something ; when not at play, they refer 
to eating ; the father and mother find more pleasure in 
giving than in restraining. They but seldom encounter 
the labour of thinking of consequences ; and the child is 
not only allowed to eat until distension becomes painful, 
but it takes sometimes the most stimulating food ; fre- 
quently is excited by the offer of compounds ; most gene- 
rally with that favourite article, found in so many houses, 
commonly called CAKE. This abominable compound, 
first used only for the purpose of stimulating the worn-out 
stomachs of the intemperate, has disordered and destroy- 
ed millions of children. Either of its component parts, 
separately taken, is healthy ; it is when compounded, that 
it is pernicious. The appetite for it is artificial ; and as 
children have the strongest relish for the most simple food, 
when confined to it, (as for the mother's milk,) it is infi- 
nitely better that they should never have such excitements. 
It ought not to be allowed, if for no other reason, than the 
uneasy feeling many other children have, in not partaking 
of an article deemed so good. I have no hesitation in de- 
claring that its use is as pernicious as dram drinking ; that 
no child under five years ever eat it without injury visible 
or secret to his constitution. You may perceive how pow- 
erfully the compound operates, by having two children 
under the same circumstances, both accustomed to simple 
diet ; give the one at night cake to eat, none to the other: 
watch the sleeping ; an^l the starts, the restlessness, if not 



the screams, will proclaim, which took the disordering 
compound. Sweetened light bread is the substitute, but 
no substitute is wanted ; the more simple, the more agree- 
able will be the diet. 

Children ought never to be allowed to eat too much : 
the means of preventing such gluttony, is to give them 
some light article to eat, before their regular meals, which 
prevents that eagerness to eat, which naturally leads to ex- 
cess. They should always, the moment they awake, take 
something to eat. In giving them new articles of diet, the 
commencement should be with small quantities, to habituate 
the stomach to its digestion. It is excesses, compounds? 
and irregularities in diet, which have produced so many 
small persons. A return to the old simple diet of the an- 
cients, would be followed by a restoration of the size of our 
species. 

The time for weaning children, generally the critical 
time of teething, is next to be noticed. This varies in 
every country ; indeed in each family so considerably, that 
it is impossible to give any thing satisfactory on the sub- 
ject. The general rules are, by all means to habituate the 
child for weeks before to a different diet ; by no means 
suddenly to withhold the breast. Next, the time for wean- 
ing should always be taken when the child is in a healthy 
state. The substitute for its diet, ought at first to be that 
which was recommended for children in early infancy, 
the mildest articles 1 . Children have done well when wean- 
ed at the fourth month ; but unless some state in the mo- 
ther renders it improper, it is best not to deprive them of 
the breast before the ninth month. When the parents are 



256 

of small stature, it is best to keep the child longest at the 
breast, as in all other animals it appears to have the effect 
of increasing their size. Judging from comparison, and 
from a few observations, I have no doubt such a course, 
not destroyed by stimulating diets, or drinks, or premature 
venery, would have the effect of greatly enlarging our puny 
breed of men and women. 

The next subject for consideration is the teething of 
children ; an operation which has probably caused the 
death of more children than arty one to which they are lia- 
ble ; and all from the ignorance and fears of the attend- 
ants, often supported by the conceits of their physicians. 
The important connection between the mouth and all parts 
of our body, has already been dwelt upon. It is not, there- 
fore, surprising, that such great variety of diseases should 
follow the irritation in the mouth during teething. 

The time of cutting the first teeth is irregular ; from the 
third to the fifteenth month ; generally between the seventh 
and ninth. There are two stages in this operation ; the 
first is about the third or fourth month, marked by slaver- 
ing, when the child delights in having its gums rubbed ; 
sometimes they have fevers, fretfulness, and diseases of the 
bowels. The second stage is about the seventh month, 
when the teeth are penetrating the gums. The gum is 
swelled, and too painful to allow the slightest touch ; as 
tile tooth is about to appear, a white blister appears over it. 

Children have often most difficulty in cutting the first 
teeth ; which, if they come in proper order, are, the two 
lower front teeth, then the two above them ; but when the 



2j7 

qaual time of their coming has past, the two upper teeth 
will sometimes appear first, then the two eye teeth ; but 
the appearance is very irregular, and not material. About 
the seventh year, these teeth, give place to new teeth. 
In order to prevent the diseases so often attendant upon 
teething, it is necessary to watch the first symptoms of 
disease, and invariably to scarify or cut the gum, at the 
same time giving some laxative medicine, and lessening 
the diet. In the first stage, it may be difficult to discover 
which gum ought to be cut, but when disease is violent, it is 
best to cut all over the gums in front. Whenever the gums 
are swelled, it is then of the utmost importance to cut them 
freely ; a common penknife, or thumb lancet, will answer, 
and any mother's or father's hands, just as well as a sur- 
geon's. The first object is to draw blood from the part ; 
then, if the symptoms continue bad, to cut down to the top 
of the tooth. There is no danger of hurting the child ; in- 
deed they derive such relief, that often they open their 
mouths for it, when once relieved. Their gums are very 
insensible, excepting when, from neglect to scarify them, 
they are inflamed. Nor need you be afraid of hurting the 
teeth, as they ascend, covered with their enamel. 

A ridiculous idea prevailed among physicians for some 
time, that cutting the gum gave present relief, at the ex- 
pense of future pain; that the scar formed when the 
wound healed, was more difficult of penetration by the 
teeth. To this day, some are ignorant enough to believe 
in the doctrine, and refrain from relieving the suffering 
children, as if their gums could not be cut every day, if ne- 
cessary, even if their notions were true. But the fact is 
the reverse. All new formed parts are more easily de= 
stroyed than old ; they more readily dissolve, or disappear. 



258 

as instanced in the cicatrix, or new formed flesh of old 
sores. To cut a gum over a tooth which has not appeared 
to rise, is therefore rather of service than injury to its 
future passage. The greatest surgeon who ever lived, 
Mr. John Hunter, of London, writes, " it often hap- 
pens, particularly when the operation of cutting the gums 
is performed early in the disease, that the gum will re- 
unite over the teeth ; in which case, the same symptoms 
will be produced, and they must be removed by the same 
method. I have performed the operation above, ten times 
upon the same teeth, when the disease had recurred so 
often, and every time with the removal of the symptoms." 

I do sincerely wish I could prevail on all mothers or 
fathers to undertake this gum lancing. Nothing is more 
simple, or more easily performed ; it never does harm, and 
it would so much lessen the sufferings of the little children, 
that I should be happy in the recollection. It is best for 
the child to cry when lancing the gum, as the mouth is 
then most opened, and the cut may be directly on the top 
of the tooth. In some cases, where there is reason to be- 
lieve the teeth to be advancing, yet no visible sign, great 
relief has been obtained by cutting down to where the tooth 
should be, thereby letting out blood, with probably some 
little irritating matter, producing violent action in the sys- 
tem. If you will not do it yourselves, I beseech you to 
insist on your physicians frequently performing the opera- 
tion. 

I have not dwelt upon the diseases incident to teething, 
because they are so numerous, and vary almost in every 
child. The most common are, affections of the bowels 
and convulsions. When these or other violent complaints 



259 

appear, or are apprehended, the child should be blooded, 
by cupping about the lower extremities, and purges be 
given, with the zvarm bath, (not hot) to take off the irri- 
tation. The gums, of course, to be freely lanced. The 
rule I have adopted, and would prescribe to all, is, what- 
ever may be the inflammatory affection of the child, if it 
have slavered freely, before, or if it be the time for the 
teeth to appear, by all means to cut the gums, so that they 
shall bleed freely. 

All parents should be apprised of the importance of 
teaching their children how to command their own minds 
in early life. The numerous ungovernable spirits we see 
daily in society, originate from the folly of neglecting this 
important object. I make the assertion in the fullest con- 
fidence of its truth — that there is no child which cannot 
be trained, and with but little trouble, to aay habits of self- 
command. It only requires a good beginning. The first 
correct practice is to prevent them from getting in the 
habit of crying ; to make them suppress their cries, at 
least loud crying; which is not only horribly annoy- 
ing to others, but calculated to produce convulsions in 
the child. Whenever they are heard to cry, enquiry 
should be made into the cause, and their attention di- 
rected to some other point. A little perseverance in 
the beginning, will soon be crowned with success ; and it 
is indeed worth a long attention. The ability to suppress 
cries, will be followed by ability to command other feel- 
ings. The example of submission in the eldest child, will 
have great influence over the younger ; so much, that half 
the discipline will suffice with them. Children so brought 
up* do not require or receive a tenth part of the correction 
of those punished irregularly, or, as it is termed, by fits 
and starts. The practice I have pursued with my chil- 



260 

dren has been, to begin early with punishment, never to 
suffer disobedience in the slightest degree ; never to with- 
hold one proper gratification they desired ; never to allow 
one that was improper ; and the consequence has been, 
that no children less frequently require punishment. 

In concluding this letter, I feel some pain at the appre- 
hension that I have not said enough to induce a strict ad- 
herence to the practices recommended. I knew them to 
be so judicious, that I felt as if argument were useless. 
The subject is those, of whom our Christ declared, " of 
such is the kingdom of heaven !" Ladies, if youfeel as 
mothers, if you have souls to partake of the heaven of 
doing good to innocence in pain, you will not require long 
arguments to adopt practices promoting the health of 
children. I ask — I pray you— -if I have not urged suffi- 
ciently to induce you to do it, then, as a favour, as a kind 
compliance, in return for the wish I have to serve, imme- 
diately prescribe — 

1. That all little babes shall sleep with their mothers or 
nurses, in the safe manner pointed out. 

2. That until their constitutions are formed, their diet 
shall be simple, and of the same kind. 

3. That they shall be kept warmly clothed; never 
exposed to sleep, breathing a foul, close air j nor with 
windows open. 

4. That every morning, from birth, for at least two or 
three years, they shall be put in a tub of warm water and 
washed. . 

5. That they shall be, as far as practicable, got in the 
habit of evacuating their bowels at the same hour. 

6. Lastly, though not least, that whenever their gums 
appear in the least inflamed, you will, or will have them 
freely and often cut. 



mi 



LETTER XL 



Contents. Diseases of children— first month — colds—?* 
eruptions on the skin — sore eyes — swellings and excoria- 
tions — hooping cough — croup — of xvind in the stomach 
and bowels — of sickness, &c. — sore head — -measles — -of 
colic — convulsions — of fevers — of worms— of chicken pox 
— ofcozu pox — of chilblains — of scalds and burns — of the 
itch — of scald head — summer complaint. 

The treatment of the disorders of children ought to be 
understood by every mother ; as well for the purpose of 
giving occasional relief, when a physician cannot be had, 
as to prevent injudicious meddling with their complaints. 
Improper doses, at improper times, have probably caused 
the death of more children than have been relieved by me- 
dicine. 

The first thing to be impressed on the parent's mind, is, 
that the bodies of their children are governed by the same 
laws as their own ; and the cure of their disorders is to be 
effected, not by doses operating as charms, but by the ap- 
plication of the principles of medicine to their particular 
case. The great variety of prescriptions for the diseases of 
children, in almost every old woman's head, should be 
abandoned ; but few medicines, and those of the most sim- 
ple kind, are wanted for them. 

From the moment a child is born, its system assumes 
more or less an inflammatory state ; its diseases are almost 
invariably those of high action, requiring evacuations and 

i. 1 



sag 

medicines, to determine to parts not affected. The prac- 
tice is so simple in most cases, the treatment so well laid 
down by other writers, that I shall confine myself merely 
to making extracts from them. From the works of doc- 
tors Moss and Burns, the following is taken. 

OF COLDS. 

" In the first month, most children are affected with colds; 
commonly in the nose, and called snuffles. Warming the feet 
at the fire, will often be sufficient to cure them. But when 
the disease is attended with fever, it is best to administer 
a vomit. This may be of three grains of ipecacuanha, or 
of one grain of tartar emetic, in four table spoonfuls of 
warm water, and one tea spoonful to be given every thirty 
minutes, until vomiting is produced. The bowels should 
be kept open with magnesia, rhubarb, manna, or castor oil, 
in small doses. I would recommend a repetition of the 
vomit, if the first do not relieve. 

ERUPTIONS OF THE SKIN. 

" Children, particularly those not daily put in a tub of 
warm water, are very subject to a great variety of eruptions 
on their skin, commencing sometimes in the first week of 
their birth. Different names, as red gum and white gum, 
are given to each kind ; but it is useless, as they vary 
much, and require nearly the same treatment. In the red 
gum, there is a number of small, elevated red spots, scat- 
tered over the trunk of the body, and sometimes on the 
cheek or forehead ; on the feet the spots are still larger, 
and contain occasionally a clear fluid. In some stages it 
resembles the measles. Generally no medicine is requisite; 



263 

but if it suddenly disappears, and the child shows symp- 
toms of internal disease, an emetic or purgative ought to 
be given, and repeated, if not at first relieved. The white 
gum appears after the red gum, resembling the itch, with 
white, shining little blisters, containing a little clear fluid. 
There are other varieties of these eruptions of the skin, 
but few of them require medical treatment. A vomit or 
purge to clear the bowels, generally relieves. The preven- 
tion is in great cleanliness, free washing daily in soap and 
water, with regularity in .nursing. When these affections 
of the skin are attended with fever, they require treat- 
ment, such as for common fevers, with applications to 
the parts inflamed, to lessen the action ; cold lead water 
and sweet oil, are the best for this purpose, 

" Sore Eyes. Children are very subject, sometimes 
during the first month, to inflammations of their eye- 
lids and eyes, particularly those whose parents neglect 
the great preventive of their complaints, setting them 
every morning in a tub of warm water. At whatever 
time the inflammation comes on, in slight cases, cold wa- 
ter alone ; after a few days, a very weak solution of sugar 
of lead, fifteen grains to the pint of water, should be ap- 
plied every two hours to the part. If it do not speedily 
subside, a purge of oil should be given, to relieve the in- 
flammatory state of their bodies. The inflamed eye 
should never be turned towards the fire, and the hand of 
the infant so confined, as to prevent rubbing the part. In 
cases where the inflammation of the ball of the eye is 
great, a leech should be applied to the eye-lid, also cup- 
ping about the temples ; and if the child be a few months 
old, bleeding four or five ounces may be necessary to save 
the sight of the eye. 

"This cold and lead water alone is the proper application 



264 

to the eye, and nothing should be added excepting where 
the eye-lids adhere together. In this case, the mildest 
sweet oil, mild hog's lard, or any bland grease, should 
be applied to the edges. A want of the knowledge to 
cool, and evacuate at once, and effectually, the children, 
and avoid every stimulating application, in inflammations 
of their eyes, has been the cause of the frequent loss of 
their vision. I trust, that no parent, hereafter, will suffer 
any other application to their children's eyes, unless from 
the recommendation of some eminent physician. 

** Swellings, Excoriations, For any swelling of an inflam- 
matory appearance, marked by red colour, heat, and pain ; 
the part should be bathed in a solution of lead, of thirty 
grains to the half pint, and a rag wet with it be constantly 
applied. When the inflammation is considerable, purg- 
ing is proper, also bleeding near the part, by cupping. 
When the skin is rubbed off, (termed excoriation,) as is of- 
ten the case, between the legs, behind the ears, in the hair, 
between the toes or fingers ; this lead water should be appli- 
ed, and then sweet oil. In cases of inflammation, a poultice 
of Indian corn meal, wet up with this lead water, and kept 
applied to the part during the night or the day, has greatly 
expedited the cure. When the excoriations or sores have 
been of long standing, you should, by all means, on dry- 
ing them up, purge the child once a week, for three or 
four weeks afterwards ; also, diminish its food. The ne- 
glect to do this, or to make a slight issue or sore, by 
means of a small blister plaster, applied and kept to some 
part of the body, two or three hours every day, for a week 
or two, has often been fatal ; as the system, when the old 
sores are healed, not having its accustomed irritation, takes 
en violent disease in other parts. I will add, that the pre- 



2G5 

ventive of these complaints, is, daily washing the whole oi 
the body in a tub of warm water, and clean clothing. 

" Hooping-cough. There is no disease more generally 
treated improperly by parents, than the hooping-cough. 
In the beginning, it is always an inflammatory complaint, 
requiring evacuations and determination of blood to the 
surface of the body. Instead of the variety of prescrip- 
tions in daily use, give the child an emetic, to be repeat- 
ed every day or other day, unless the symptoms lessen. 
For a violent fit of coughing the best remedy is, to pour 
in the back of the mouth a tea-spoonful of melted hog's 
lard, which sheathes the part, and lessens the irritation. 
The tincture of asafostida is highly recommended. A 
child, grown enough for the purpose, will find some re- 
lief in holding very hot water in the back of the throat. 
It is of great importance to children in this complaint, to 
keep their skin in good state. A coarse flannel shirt, in 
some cases ; in others, a very rough piece of oznaburg 
around the breast, have been of great service, by keeping 
up friction. With the flesh brush, or a ball of wool, the 
surface of the body should always every night be rubbed. 
Exercise in open air, while the body is kept comfortable, 
is immensely salutary, as well as change of residence for a 
few weeks. 

" Of the Croup. The treatment of this disease, the croup, 
ought to be understood by every mother. It is known by 
a singular hoarse, hollow kind of breathing, and by symp- 
toms approaching to suffocation. Those living in rooms 
warmed by stoves are most subject to attacks of it. The 
remedy is an emetic, the instant the attack commences. 
When practicable, in violent cases, blood-letting by the 
lancet, or by cupping, should be prescribed. In general, 
repeated emetics effect a cure. The child should be kept 



266 

reclining in a tub of warm water, and the emetic be given 
every ten minutes, until the difficult breathing is lessened. 
When the choice of emetics can be had, seven grains of 
tartar emetic, in as many spoonfuls of warm water, half a 
spoonful poured down the throat every ten minutes, so as 
keep up a constant deadly kind of sickness and vomiting, 
will be the best. When the determination to the throat is 
relieved, the child is to be treated as in common fevers, by 
purging and other evacuations. But remember, the means 
of exciting vomiting and sickness at stomach, with deter- 
mination to the skin, by hot water, are not to be abandon- 
ed until the distress of the breathing is relieved. In the 
case of one of my sons, attacked about two o'clock in the 
morning, with perfect success, I kept him vomiting every 
ten minutes for five hours, frequently introducing in the 
back of the throat, a small feather well oiled, to hurry 
the operation. 

" Wind in the Stomach and Bowels. A child, like a grown 
person, may have wind upon his stomach, which may be 
troublesome and uneasy to him, without griping him, or 
sensibly affecting or disordering his bowels, as is discover- 
ed by his not being so cross with it as a child is when 
griped. A child is discovered to have wind upon his 
stomach, by the wind often rising into his throat, which 
makes him struggle at times as if to get his breath, and 
from which he is occasionally relieved by the eructation 
or breaking of wind upwards ; and, as it often returns 
upon him, it becomes very teasing, and interrupts his rest : 
he generally takes his food unwillingly. It is common 
with children in the month who are dry-nursed, and before 
they begin with what is called possetting. 

" A variety of things are given upon this occasion to dis- 
pel the wind, some of which have been enumerated : but 



267 

none of them, nor any thing else that I have seen given to 
procure a temporary relief, exceeds spirit of hartshorn, or 
hartshorn-drops, as they are commonly called. Three 
drops of the hartshorn may be given, to a child in the 
month, in about half a table spoonful of cold water, and 
repeated two or three times in the day, or as there may be 
occasion. Hartshorn, when it will answer the purpose, is 
to be preferred to cordials, spirits, seeds, spices, and hot 
things of any kind : as, although it is fully as powerful in 
dispelling wind as any of them, it will not, by a permanent 
heat, nor by repetition, injure the stomach as they* do ; nor 
can any bad habit or other disadvantage arise from giving 
and repeating it as often and long as it may be necessary 
so to do. It is endowed with a property which makes it a 
desirable medicine for children ; which is, it corrects and 
removes acidity or sourness, a principal cause of griping 
with children. Its use in these intentions is well known 
by grown up persons, with whom it is a favourite and fa- 
miliar medicine : and the reason why it is not extended 
more generally to children, proceeds, I imagine, from a 
supposition that it is too strong. for them; but which is a 
mistaken notion ; as it may be given, as above directed, 
with the utmost ease and safety. The dose here mention- 
ed is the smallest that need ever be given, and it may be in- 
creased as a child grows older, especially, to four, five, or 
six drops. 

" As wind upon the stomach is, with a child as well as a 
grown person, to be considered as a mark and indication 
of a weak stomach and indigestion; so it will be observed 
to be most common and troublesome to those children who 
are dry-nursed, and fed with food of an improper quality, 
as bread, thick and rice milk, &c. which cannot digest and 



MS 

pass the stomach so perfectly and readily as it ought to do : 
for we all know, that whatever is heavy of digestion, and 
lays long upon the stomach, is not only uneasy, but also 
causes wind there ; and cannot but be sensible how much 
these painful sensations must be increased, if we were com- 
pelled, as infants are, to a constant repetition of the food 
which occasioned them. Many weakly, puny children, 
who are even wet-nursed, will now and then be observed 
to have a wind upon their stomachs ; (and the hickup, 
which they all have at times, is occasioned by it) ; as also 
those w'no are most carefully fed in dry-nursing ; but when 
it occurs only now and then, and that slightly, it is not 
worth notice ; and if any attack of it should seem more se- 
vere than usual, the hartshorn and water will most likely 
relieve it. The occasions which call for a more particular 
attention, are those where, as above named, when the child 
is dry-nursed, he takes his food unwillingly, and swallows 
with difficulty, from the wind rising into his throat, and 
that for some successive days, a week, or longer. When- 
ever, therefore, the complaint appears in this latter form, it 
will be necessary to pay the strictest attention to his food, 
and by no means to force more, even of such as is the most 
suitable, than he is disposed to take willingly. If he is 
costive, it will be proper to give him a little manna, or a 
tea spoonful of castor oil. 

" Wind upon the stomach, when to excess, and occasion- 
ed by the constant use of improper food, is often a presage 
and forerunner of an alarming sickness, that frequently ter- 
minates in a severe griping and looseness, as described in 
the article immediately following. 

" Children also, like^ grown up persons, seldom have 
wind in their bowels without being griped by it -, but which 



2-S9 

they will sometimes have, without being either costive or 
too loose in their bodies. When it so happens, it most 
commonly proceeds from cold, and will generally go off in 
a short time. The hartshorn may in this case be tried, aU 
{hough its effects will not always be so striking as when 
the wind is in the stomach ; and if it does not ansWer, re- 
course may be had to geneva and water, anise, or fennel- 
seed tea, &c. If these fail, and the complaint increases, it 
must be treated as a griping without looseness. 

" Some children seem naturally more subject to wind in 
their bowels than others ; and which can be accounted for 
no otherwise, than as proceeding from a particular weak 
and tender state of those parts. And as it is much in- 
creased by cold, a particular attention must be paid to keep 
and defend those children who are liable to it, from taking 
cold, by a proper regard to the closeness and warmth of 
their dress, and by keeping them out of the air in the first 
or second month, 

A sickness, with or without throwing' up. Infants are 
very subject to a sickness the first or second week. Some- 
times they throw up with it ; and at other times they do 
not, but lie in a dozing state, without motion, the lips pale 5 
and a paleness and sinking of the face ; and they generally- 
refuse their food, or do not take it so freely as at other 
times, seemingly owing to their being stuffed and full at 
the stomach, and not able to get it down. The stomach 
commonly feels hard, and is sensibly swelled and enlarged. 

" A throwing up, or possetting, as it is commonly term- 
ed, is seldom esteemed an unfavourable circumstance with 
young children ; yet the sickness that happens at this ear« 
ly period is generally from a widely different cause with the 
possetting, which rarely happens so early ; and when it 
does, proceeds from a natural and not unfavourably 

m m 



270 

cause ; whereas the sickness that comes on at this time, 
whether accompanied with a throwing up, or not, is unna- 
tural and unnecessary, and therefore not desirable. In 
possetting, what comes up, is in a digested state ; whereas 
what comes up at this period, and upon this occasion, is 
scarcely changed or altered from what it was when it went 
down : and, if it is altered, appears in hard curdled lumps. 
From which it clearly appears, that the cause of this sick- 
ness, as here described, with or without throwing up, and 
which is so frequently observed to happen during the first 
three or four days, or as long as the child is fed with a 
spoon previous to his getting the breast at all, or so suffi- 
ciently as to satisfy him without feeding with a spoon, is 
altogether occasioned by the food that he takes, which, 
not being suitable, disagrees, and therefore will not digest 
and pass the stomach as it ought to do, but remains unal- 
tered, till nature, by an effort, relieves herself by a sick- 
ness, or a looseness : but until this sickness, or looseness, 
or both, take place, and while the food stays upon the sto- 
mach, it lies there as an oppressive load, and the child is 
overcome and overpowered by it ; which accounts for the 
child's looking so pale, and otherwise ill. This sickness 
at stomach, without throwing up, is a very common cause 
of alarm, and much uneasiness and anxiety to the mother 
and friends, who suppose the child, from the apparent great, 
and oftentimes sudden alteration in his look, must be in a 
dangerous situation ; although, notwithstanding the alarm- 
ing appearances, it is very rarely attended with immediate 
danger ; and, when the cause is known, may, by proper 
means, be readily removed, and a return of it prevented. 
The means to be pursued for these purposes are, first, to 
remove the load from the child's stomach, which will give 
him immediate relief, as will be perceived by his resuming 



871 

his former look ; and this will often be done, by giving 
him a tea-spoonful of castor oil, or a little manna, so as 
to obtain a free passage, which may carry the complaint off 
by stool ; but if this should fail of giving the wished-for 
relief, the antimonial puke will scarcely fail of fulfilling 
the intended purpose. To prevent a return of the sick- 
ness, with or without throwing up, the child's food must 
be strictly attended to ; and if (as is generally the case) it 
happens before the child gets the breast, he had better not 
be fed again until he can have the breast : but if food or 
nourishment from the child's real, and not imaginary weak 
state, is absolutely and immediately necessary, it must be 
given of such kind as may be reasonably expected to agree 
better, and such as has been advised when treating of food 
and diet. 

" This complaint is very common, at this early period, 
with those children who are dry-nursed, or those (espe- 
cially weakly children) who are fed, in the usual manner, 
before they get the breast. It is a common attendant, or 
rather fore-runner of gripes and looseness. It is more 
rare and less frequent with those who are not fed at ail, 
or properly so, before they get the breast : and when they 
come to have the breast plentifully, and take it freely, they 
seldom have any returns of it. It is not, as before observ- 
ed, immediately dangerous ; yet if it is neglected, by suf- 
fering the cause of it to be repeated and continued, it may 
lead to severe gri pings and looseness, that may, and often 
do, prove fatal. 

" This sickness, obstruction, and oppression at the sto- 
mach, will always occur in a greater or less degree when a 
child gets the breast the day he is born, which generally is 
the practice where hired wet-nurses are engaged, and 
which I have often observed to occasion uneasiness and 



S7S 

distress to the tender sufferer. All these are certain truths, 
and strongly point out the impropriety of anticipating the 
process and interrupting the order of nature in her own 
invariable operations, by a blind attachment to prejudice 
founded in ignorance. Man has a disadvantage with the 
rest of the animal creation, in this and some other of the 
simple operations of nature, who seldom errs, except when 
interrupted by the art of man. 

" A sickness seldom seems so alarming when a child 
throws up with it ; as throwing up from time to time re- 
lieves the stomach, and the child is disposed to take food, 
and does not seem so dull and heavy ; however, as the 
food does not digest, and is chiefly returned unaltered, or 
else in hard curdled lumps, it can afford little nourishment; 
and what happens to pass the stomach will do more harm 
than/ good, by causing a griping and looseness ; all which 
will, in the end, terminate as unfavourably as in the case of 
sickness without throwing up. 

u This case of heart-sickness, as it is commonly called, 
when not accompanied with a throwing up, and which is 
very common to children in the first or second week, for 
the reasons already given, is not very generally understood; 
for when a child lies in a dull, heavy state, without motion, 
refuses his food, and, as is common in cases of heart-sick- 
ness, looks pale, sunk, and fallen, without any obvious and 
visible ailment, it is supposed undiscoverable, and that any 
means to relieve him will be needless and of no avail ; 
however, from the description and account here given of 
it, it can scarcely be mistaken, and may as certainly be 
palliated, or entirely removed, by means here recom- 
mended. 

" Children, with this complaint, will often have wind 
upon their stomachs i which becomes very troublesome to 



273 

them, especially in swallowing their food, and is occa- 
sioned by the same cause ; namely, an imperfect digestion, 
as has been explained in the preceding article. 

" Complaints in the stomach and bowels are commonly 
so connected, and interfere so much with each other, that it 
is sometimes difficult to disunite and properly distinguish 
them. The preceding complaints, of, and in the. stomach 
and bowels, here treated of, are the most common and ma- 
terial. In describing them, I have not been inattentive to 
what authors have said upon them ; yet as some of them 
have not, so far as I know, been noticed by authors ; and 
as they are frequently so interwoven, and depend so much 
upon each other, I have given and described them exactly 
in the manner and form they have repeatedly appeared to 
me in practice. And although description of the most simple 
complaints may, to those who are perfect strangers to them, 
at first sight, appear somewhat strange, and difficult to 
conceive clearly; yet, there can belittle or no doubt, but that, 
by a careful attention to the descriptions here given, and a 
little acquaintance with the ways, appearances, and treat- 
ment of children, these will be clearly, properly, and easi- 
ly discovered and distinguished. I have been more full 
and particular upon the complaints of the stomach and 
bowels, and the causes that produce them, than most of 
the other complaints of children ; for which I need offer 
no other apology, than that they are the most frequent 
and fatal, and perhaps the least understood ; or, at least, 
that they are seldom so properly attended to as their inv 
portance requires. 

If due attention was paid to remedying and preventing 
these complaints, the advantages to society would be very 
considerable, as it would be a means of preserving a num- 
ber of the species that we see daily dropping into an un- 



274 

timely grave; and with them, the fond parents' great 
dependence, and chief delight. If proper accounts were 
kept of the causes of the death of those children who are 
dry-nursed, and die under four months throughout the 
kingdom, it would, most likely, appear, that two-thirds or 
even three-fourths of them die of complaints in the sto- 
mach and bowels, evidently occasioned by a disagreement 
of their food. And if the same account of the causes of 
the death of those who die within the week from the birth, 
it would as likely appear that the same proportion are car- 
ried off by the same complaints, even if they are intended 
to be wet-nursed ; and which happens from improper feed- 
ing before they get the breast. 

" Of how much importance it is, therefore, to the comfort 
and happiness of the parent, and the ease of her tender 
and suffering infant, to have this article of the diet (fre- 
quently by an error in it, of such alarming and fatal con- 
sequences) properly regulated ; and how much it behoves 
her to assert her just authority, in defence of it, against 
any other opinion that is directed by bigotry and igno- 
rance ; which generally, solely, govern and prevail upon 
these occasions ! 

" From what has been observed of the complaints in the 
stomach and bowels at this tender age, it seems highly pro- 
bable, that, could those children who are intended to be 
brought up by hand, or dry-nursed, be but indulged with 
a breast for three, two, or even one month, from their birth, 
their stomachs and bowels would, in that time, acquire so 
much strength as to prevent the complaints, either alto- 
gether, or in a great measure. 

" The Thrush, Frog, or Sore Mouth, is a complaint which 
children are subject to from the end of the first to the be- 
ginning of the third week. It is very commonly known 



%1o 

and distinguished by the name of a sore mouth, which it 
really proves to be to the poor infant, as it is mostly at- 
tended with a good deal of pain and uneasiness, especially 
in feeding, in sucking most particularly. The appear- 
ance in the mouth is, as if the child had been eating curds, 
and that some of them remained sticking upon the tongue, 
to which the complaint and soreness are at first chiefly 
confined ; but afterwards it will spread all over the inside 
of the mouth, and be extended to the throat, stomach, and 
bowels. 

" This is a very common and frequent complaint : when 
it happens, it proves troublesome, and ought therefore to 
be closely watched, that, when it appears, its departure 
may be hastened and expedited as quickly as possible. 
Whenever, therefore, any white specks, or matter like 
curds, are observed to be sticking upon the tongue, so fast 
as not to be readily washed or rubbed off, it may justly be 
supposed the sore mouth is commencing. 

u If the child at this time is in the least disposed to be 
costive, a little manna or magnesia must be given to pro- 
cure one or two loose stools ; and which may be repeated 
afterwards, if the body does not keep gently open. It will 
be necessary to have the tongue frequently cleaned ; for 
which purpose many things are recommended, as honey, 
borax, alum, white vitriol, &c. Borax is to be preferred 
to any thing else, as it is very effectual, and much safer 
than the others. It must be powdered, with or without an 
equal quantity of loaf sugar ; and is to be made use of by 
tying a piece of linen rag upon the mouth or shank of a 
tea spoon, which must be dipped in the powder, and the 
tongue rubbed with it two or three times a day ; and it 
must be regularly persevered in daily, while any appear- 
ance of the complaint remains j although, in doing it, the 



276 

child will receive some pain, especially if the complaint has 
been suffered to increase before proper attempts are made 
to remove it ; but when it is taken early, and at the begin- 
ning, the mouth will be kept tolerably clear and free, with- 
out paining the child ; by which he will be enabled to feed 
with much more ease, and the complaint will be got rid of, 
in a tolerable easy manner, in the course of seven or eight 
days. The colour of the specks upon the tongue are, as 
has been observed, at first white ; yet it is very common 
for them, when the complaint is of some standing, to turn 
yellowish, and brown ; upon which occasions they gene- 
rally come off, at last, in sloughs. 

" When, from neglect, or any other cause, the complaint 
has continued for some time, it is very common for the 
child to have a degree of fever, very often accompanied 
with griping and looseness, with watery, sour, green stools; 
in which case the disorder becomes more alarming and 
troublesome. 

" As this complaint is occasioned by an imperfect or im- 
proper digestion of the child's food ; so it is very liable to 
be brought on, and greatly aggravated, by improper food ; 
it will therefore be very necessary to pay a strict attention 
to the diet at this time, if the child is dry-nursed ; and to 
the mother's or nurse's diet, if otherwise. 

" When the looseness is great, the complaint must be 
treated as a looseness from any other cause. Of all medi- 
cines, the antimonial puke is most eminently serviceable in 
this state of the complaint, and is often attended with the 
happiest effects, and therefore ought not to be omitted : it 
may be given once a day, while the complaint continues : 
as it commonly operates both upward and downward, it 
clears away the offending matter from the stomach and 



«72 



bowels, which is the cause of the complaint, and also of the 
fever ; by which means the most sensible relief is obtained. 

" When the thrush is neglected, and suffered to continue 
until it is communicated to the bowels, (as it begins first in 
the mouth, and is extended gradually and regularly down- 
ward,) the stools will frequently be so sharp and acrimoni- 
ous as to inflame the child's backside, and make it trouble- 
somely sore ; and which is the most certain proof and in- 
dication that the complaint has reached the bowels. When 
this happens, the parts that are red, inflamed, and sore, 
must be kept as clean as possible, and often washed with 
cold w T ater. And, if the soreness increases, it will be pro- 
per to bathe them with lead water. 

" The thrush is infectious; that is, it may be communi- 
cated to a child by a nipple that has been in the mouth of 
another child who has the complaint. 

"The cause of this complaint has not been yet generally 
agreed on. During many years particular attention to it, 
I have scarce ever seen a case, when a child was dry 
nursed, without more, or less, of the complaint, but, most 
commonly with some severity, where means were made 
use of to remove it. On the contrary, I have never ob- 
served the least appearance of it where the child had no 
other food from his birth but the breast. I have frequent- 
ly observed it when a child has been fed with improper 
food, till the breast was ready for him ; and much seldom- 
er when he has been so fed with more proper food. From 
which I have long concluded that the cause is improper 
food ; and that the complaint may be ranked with many 
other injurious consequences (already named) from the 
same baneful cause. 

" A yellowness of the skin, which very often overspreads 
the whole body, is very common with infants a few days 

x n 



%7& 

after they are born ; it sometimes continues for some 
weeks, during which time it often becomes of a deeper yel- 
low, or orange colour. It is not to be regarded, nor is 
any thing needful to be done to remove it, as it will disap- 
pear totally and spontaneously at last. It is commonly 
said that the skin is left clearer and fairer by it than it 
otherwise would be without it ; which seems a doubt : 
however, it is an agreeable delusion, and may help to* re- 
concile so unpleasing an appearance. 

Some children will have milk in their breasts a few days 
after birth, and which is commonly pressed out by the 
fingers of the nurse. If the breasts are much swelled and 
inflamed, this pressure, if forcible, will give considerable 
pain, and may be attended with worse consequences, and 
more uneasiness to the child, than can happen if nothing is 
done ; and if the swelling is trifling, forcing out the milk 
is less necessary. In all cases, the pressing out of the 
milk is better avoided, and any swelling and hardness that 
may happen, will be better assisted by a little olive or 
goose oil rubbed gently on, once or twice a day ; the milk 
being left to disperse or discharge itself naturally; the lat- 
ter of which often happens, with the most trifling assist- 
ance ; and whenever assistance by pressure is given, it 
should always be of the most gentle kind, and such as can 
give little or no pain. 

Sore and Scald Head* By a sore head, is meant, a com- 
plaint, in some places known by the name of reef or felon : 
it often begins upon the forepart of the head, in large white 
scabs, which, if neglected, spread ail over the head, and 
mostly break out upon the forehead and face, in large 
patches, at the same time : it sometimes, generally at the 
beginning, is dry ; at other times it is moist, and has a thin 
discharge. Medical writers have named this complaint. 



279 

crusta lactea, or milky crust, from its appearance. The 
children of the lower order of country persons, who are 
gross and feeding, are most subject to it ; and it seems to 
be occasioned by a want of cleanliness and exercise, which 
children, who have a bountiful supply of suck, require ; 
but to which parents, in this situation, are not often dis- 
posed, or seldomcr have opportunity to afford them. A 
cabbage leaf is a very common application, as it draws, 
and greatly promotes a discharge from the head, which is 
supposed necessary previous to the cure : but as such a 
discharge is no way necessary, and as it makes the head 
uncommonly offensive, it is better not to encourage it ; 
and the sooner the complaint is cured, the better : for that 
purpose, take of brandy, and water, each equal parts ; or 
one part brandy, and two of water ; mix them together, 
and bathe the parts of the head and face where the com- 
plaint is, well, once a day, and immediately afterwards lay 
on a plaster of calamine cerate (commonly called Turner's 
cerate) spread upon a linen rag, which is also to be renew- 
ed every day after each washing with the brandy and wa- 
ter. Two or three doses of physic must be given during 
the cure. Bathing- in the sea, will be of great use. 
(Try salt bath.) I have met with no cases which were 
not readily cured by these means, and with perfect 
safety to the child, notwithstanding the general prac- 
tice is so much in favour of drawing, rather than re- 
pelling or drying applications. If a child takes physic, 
no inconvenience can attend the early removal of the com- 
plaint, as I am fully satisfied of, by repeated experience. 

A child is liable to have this complaint in the first or 
second month, or afterward : it is uneasy to the child, and 
very disagreeable and offensive to the sight and smell. The 
applications must be continued while any remains of the 



280 

disorder can be discerned. If bathing in the sea cannot 
be complied with before or during the cure, it will be very 
proper, the first opportunity afterwards, to confirm the 
cure, and to prevent a return of the complaint. Oil-cloth 
(or oil-case) is often applied upon this occasion ; but can 
have no other use, nor answer any other purpose, than 
keeping the cap clean, and preventing its sticking to the 
head. This complaint appears to be more peculiar to some 
parts of the kingdom than to others ; probably depending 
upon the air and the mother's diet and habits. 

" Children of about four or more years of age, are very 
liable to sore heads, that difFer from the preceding ; as the 
soreness is confined altogether to the head, except that it 
will extend to the neck if neglected. It begins in distinct 
brownish spots, that form a scab, and discharge a thick, 
gluey matter, that sticks amongst the hair. The spots in- 
crease and enlarge so as to cover a great part of the head, 
When these spots are discovered, the hair upon and about 
them must be cut as close as possible, and they must be 
washed well, every day once or twice, with soap and water. 
If that does not prove sufficient to remove them, they may 
be daily anointed with a little tar ointment, or Barbadoes 
tar, with the point of the finger ; which rarely fails of a 
cure. The scald head, which is either this complaint in 
the extreme or nearly allied to it, may be treated in the 
same manner ; and which will be going as far as can with 
propriety be attempted by females. (Try the tar ointment.) 

" The Measles. The measles, like the small-pox, do not 
often attack young children, who will frequently escape, al- 
though the disease be in the same house with them. There 
are particular seasons of the year when the measles are 
most subject to be rife, or prevalent : the season which is 
the most common to them, is the spring. 



281 

" The signs, or symptoms of the measles, are a sickness; 
a heaviness ; a thirst ; a short, dry, husky cough, with 
hoarseness; a sneezing, and running at the nose ; and a 
running and thin discharge from the eyes, which appear 
red and much inflamed, particularly the eye-lids ; some- 
times cold shiverings. These symptoms are commonly 
slight at first, and increase till the measles come out ; which 
generally happens on the fourth day from the first attack, 
although children will frequently be much indisposed for 
a week before they come out. At the first appearance of 
the measles, they look like flea bites upon the face and 
neck, in distant spots ; but, soon after, the face, neck, and 
breast, are covered in patches, resembling a thick rash that 
does not seem to rise above the skin, although it may be 
discovered by the touch, and feel of the hand, to be a little 
prominent or raised upon the face and breast, but not upon 
the other parts of the body. The measles, like the small- 
pox, come out first upon the upper parts of the body, and 
last of all upon the feet ; and they observe the same pro- 
gressive regularity in going off. 

There is no disease, to which children are liable, that is 
so sickly, and attended with so much depression and de- 
jection, as this ; as it is very common for the most lively 
children to lay in a stupor, or state of heaviness and seem- 
ing insensibility, from the second day of the attack, during 
the whole of the complaint, which continues three davs 
after the first coming out : on the third day, the eruption 
begins to look paler ; and, on the fourth, goes off .with a 
mealy appearance upon the skin. During the whole of the 
complaint, there is a smart fever, which often, with the 
cough, and a difficulty of breathing, increase in proportion 
as the disorder advances, and will sometimes be the most 
violent and severe at the height, or turn, of the measles : 



282 

sometimes the fever, cough, and other symptoms, abate ; 
and the child recovers, in part, his spirits soon after the 
measles come out ; but this is not often the case. 

A child, in this complaint, must not be kept either very 
warm, or very cold : he ought not to be kept near the fire, 
nor yet suffered to breathe the cold air : it will be best to 
confine him to one room that is moderately and temperate- 
ly warm ; as much warmth will increase his heaviness, 
fever, and difficulty of breathing ; and cold, and cold air, 
will add to his hoarseness, and make his cough worse. 
His drink may be water, barley water, milk and water, 
balm tea, or any weak liquor ; but water, or milk and wa- 
ter, seern most agreeable to children at this time. What 
he drinks ought to be a little warmed, but not hot. Wine, 
and cordials, in all shapes, must be totally avoided. 

These are the most material precautions which are to be 
observed on the first attack of the measles j and although 
it is not always thought necessary to have recourse to me- 
dicine, and medical advice and assistance, yet they may 
frequently be employed to great advantage. It will al- 
ways be proper to give something at the beginning, to pro- 
cure two or three loose stools ; as, the infusion of senna 
and prunes, or manna: rhubarb, in any shape, is not very 
proper. Bleeding, with leeches, or with the lancet, has 
been thought necessary, particularly when the cough is se- 
vere and violent. My experience has not discovered any 
advantage from bleeding, but on the contrary, injury. It 
is not here intended to give a regular and exact account of 
the medical treatment of the measles, which would be of 
little use in a domestic line, and might perplex and embar- 
rass ; but as bleeding is so general a remedy, and some- 
times had recourse to rather incautiously in this complaint, 
a caution respecting it may not be unseasonable, especially 



283 

as cases have happened where the incautious and too hasty 
practice of it has been attended with unfavourable conse- 
quences. When bleeding is used before or at the time of 
the coming out of the measles, it will often check and re- 
tard the eruption, and will sometimes cause it to strike in ; 
the consequences of which may prove fatal : therefore, 
bleeding ought to be very cautiously ventured upon. 

" Blisters, applied between the shoulders or to the sides, 
have been found of great use in abating the cough and re- 
lieving the breathing, and may safely be applied at any 
period of the disease, when the cough and breathing re- 
quire it. (Try cupping the sides and back.) 

" A fever always accompanies the measles, and is the 
cause of the drowsiness and stupor which children always 
have in the beginning, and often during the whole of the 
complaint. Nothing will so sensibly check and abate this 
fever, remove the drowsiness, and restore a child's spirits, 
as repeated doses of the antimonial puke ; it may be begun 
with on the second or third day after the sickening of the 
child, and after the stools have been procured as above di- 
rected, and repeated, once a day at least, while the fever 
and heaviness continue ; it will be particularly proper to 
give it in the evening, at which time the fever is common- 
ly most severe; and if it operates, as it generally does, 
both by vomit and stool, it will give most sensible relief; 
the fever, heat, and oppression, will be considerably abated; 
and the child will be much more easy and cheerful, and 
more tranquil, calm, and settled and composed, than be- 
fore he took it. 

" The fever and cough will very frequently continue, 
without much abatement, for a few da}s, or a week, after 
the measles are entirely gone ; but which, the fever es- 
peciallv, may he greatly relieved, or entirely removed, bv 



£8-1 

opening physic ; a dose of which may be given as soon as 
the measles are turned ; and repeated once, or twice, in 
the course of a week. The stools, which come away with 
the physic, are generally very offensive, and the matter of 
which they are composed is, while it is retained in the 
bowels, sufficient cause for the fever ; and it may reason- 
ably be supposed to be the cause, when the relief, that 
is obtained by the discharge of it, is considered ; as the 
fever is sensibly subdued by the operation of the physic ; 
and it is on this account that repeated doses of physic are 
found so requisite after the measles ; and which they are 
as much, or even more so than after the small-pox. It 
may always be known that the fever continues, while the 
dulness, thirst, and want of appetite remain ; and, during 
which time, the physic ought to be given, at proper inter- 
vals, if no other cause forbids it. It may also as certain- 
ly be known that the fever is gone off, when the child's 
spirits and appetite return ; and which when they do, the 
physic may be discontinued. The danger from the measles 
is much increased when they happen to be connected with 
the small-pox or chincough ; and therefore, so circum- 
stanced, they require more medical attention than is gene- 
rally bestowed upon them. 

"The eyes, and particularly the eye-lids, will sometimes 
remain sore, swelled, and inflamed after the measles. The 
cough also, will oftentimes continue for some time after 
the fever and every other remains of the measles are gone. 
While either of these complaints of the eyes, or the cough 
remain, the child ought not to be suffered to go out of 
doors, or be exposed to the cold ; as the air, of a cold sea- 
son particularly, is very apt to add to and greatly aggravate 
these complaints, and may make them very troublesome 
and tedious. Too much caution, therefore, in avoiding 



285 

:oId, cannot be observed while there is any remains of 
sore eyes, or cough. It is well known that the measles 
sometimes leave behind them coughs and sore eyes, that 
continue for life ; a great part of which are occasioned by 
the single circumstance of going out too soon ; and which 
a little caution, and seasonable confinement within doors, 
would prevent. 

" When these complaints are confirmed, and of long 
standing, they seldom admit of a complete cure : they are 
sometimes relieved by issues, and a warm climate. Blis- 
ters, behind the ears, and to the back of the neck, will fre- 
quently relieve the eyes, if they are not delayed too long ; 
it will often be needful to repeat them frequently, to re- 
ceive much benefit from them. It is better to suffer the 
blisters to heal up, and to apply fresh ones, than to keep 
one constantly open by the means commonly made use of 
for that purpose." (Try frequent dry cupping.) 

u Of Cholic. Some children are very subject to cholic, 
which is easily discovered by sudden fits of crying or 
screaming, which nothing can appease, the child bends 
back the body, spurs with the feet, and then has an abate- 
ment of the pain for a few minutes, obtained sometimes 
by the discharge of wind. An attack may consist of one 
uninterrupted fit, or of repeated screaming, with interven- 
ing moments of ease. Cholic may only occur occasionally, 
er it may occur almost every night. It may be induced 
by costiveness, by cold, by damp clothes, by the liberal use 
of panado, particularly if the bread has been a little sour 3 
by passion, or some state of the nurse affecting the milk, 
by collection of wind in the bowels ; or it may accompany 
thin and slimy purging, which is sometimes produced by 
the injudicious use of laxatives. 

" In ordinary cases, nurses give gin and water, which 
o a 



286 

is a most injurious practice, and may in some instances 
kill the child. Laudanum gives speedy relief, but it 
weakens the stomach and nervous system, and produces 
costiveness. A few drops of tincture of asafcetida, mix- 
ed with oil of anise, is generally effectual, and is always 
safe.* The warm bath is useful, and if these means do not 
give relief, rubbing the belly with laudanum will be safer 
than giving it internally. A clyster of gruel, salt, and 
a little oil, is proper ; and if the child has been costive, it 
will be right to give a tea-spoonful of castor-oil, after these 
remedies have relieved, in order to prevent a return. 
(Try hot cloths from hot water to the belly.) 

" When children are subject to cholic, we may suspect 
that there is something wrong in the diet. Common pa- 
nado, especially if it contain much sugar, is very apt to 
have this effect. The nurse's milk may also be flatulent, 
and this bad property is sometimes increased by the use of 
porter or ale, intended to increase the quantity. The state 
of the child's bowels must be attended to, and he should 
not be allowed to load the stomach, by taking too much at 
a time. If he discharge wind upwards after sucking, he 
should be gently dandled, as it promotes expulsion. I am 
no advocate for giving much medicine to children, but 
when these means do not succeed, it is proper to give oc- 
casionally a few drops of the mixture mentioned in the 
note. (The fundament should be kept open, by introduc- 
ing a covered quill, as before suggested.) 

" In the more violent and dangerous kind of cholic, the 
belly is tumid and painful to the touch, to a greater de- 

* " Two drams of tincture of asafrctida, twenty drops of oil of anise 
and an ounce of mucilage of gum arabic, may be rubbed up tog-ether, 
and of this mixture, from ten to twenty drops, in a little water, will be 
a proper dose " 



287 

gree than in the former species ; the child is hot, the pulse 
quick, the face flushed, the pain and screaming violent, 
and sometime there is a great pressing, and nothing is pass- 
ed but bloody slime. As this may proceed from inflam- 
mation or obstruction in the bowels, it evidently is too se- 
rious to be committed to unprofessional management. I 
may only observe, that if the child be costive, or have not 
lately had a looseness, means should be taken, if the prac= 
titioner be at a distance, to procure a stool by a clyster, 
and the use of castor-oil or calomel, at the same time that 
the child is put into the warm bath, and rubbed with lau- 
danum. If the bowels be open, a clyster containing a 
little laudanum, can seldom be improper, if medical aid 
cannot be early obtained. (Also try the antimonial puke.) 
" Of Convulsions, Convulsions take place at any age, and 
may occur either in the course of some other disease, 
under which the child has been labouring for some time, 
or suddenly, in a state of previous health. In the one 
case they are highly dangerous, and often indicate a fatal 
issue ; in the other, they are frequently attended with lit- 
tle hazard. Convulsions, or draughts, as they are called, 
vary in degree, from a slight movement of the muscles of 
the face, to a rigid, or convulsed state of almost the whole 
body. In general, whatever be the degree of the move- 
ment, the countenance is altered, both in colour and ex- 
pression, and the patient is insensible, and cannot follow 
an object with the eye. In some instances, the motion is 
so slight, that the child may rather be said to be in a state 
of fainting, or stupor, than of convulsion. In very young 
infants, there is sometimes only a smile about the mouth, 
the eye, which is half closed, turns slowly round, the 
breathing seems occasionally to flutter, and the child starts, 
and throws out the arms on the least noise. These mo« 



288 

lions, called inward fits, frequently proceed from wind in 
the bowels. 

" Convulsions vary in point of duration, as well as of 
violence. They sometimes go off in a few seconds ; in 
other instances, they continue for several minutes. The 
child may have only one short attack, and become well 
immediately afterwards, or he may remain in a languid, 
sleepy state ; or he may have repeated attacks in a very 
short time, and continue insensible during the whole of 
the intervening period. Convulsions may be produced by 
wind, or irritation in the bowels, dependent on worms, 
costiveness, indigestible food, acrid stools, &c. ; or by 
teething ; or by breathing bad or confined air ; or by the 
striking in of some eruption ; or during the coming out of 
others, such as small- pox; or by affections of the brain it- 
self; or by other spasmodic diseases, such as hooping- 
cough, &c. I shall not enter, however, into any minute 
consideration of the causes of convulsions, or profession- 
ally into the principles on which the different points of 
practice depend. It will be more useful to observe, 

" First : That when the child has been ill for some 
time before convulsions come on, especially if the pulse 
has been quick, the skin warm, and the head affected, 
whilst these symptoms could not be traced to the effect of 
teething, there is ground to believe, that the convulsions 
proceed from a diseased state of the brain, most probably 
from water in the head. It is to be hoped, that every at- 
tentive parent will, from their previous symptoms, have 
been led to procure for their child professional advice, be- 
fore this period of the disease. 

Second : In the case of very young infants, if there 
have been no preceding disease, there is great reason to 
attribute the convulsion to the state of the bowels : and 



289 

we shall be confirmed in our opinion, by finding that the 
stools are not of a good appearance ; that there is much 
wind in the bowels ; that the child has not been nursed 
or fed properly ; that the nurse has been agitated by pas- 
sion, or committed some irregularity in diet ; or lastly, in 
infants a few days old, that the meconium is not expelled. 

" Third : When young infants have convulsions from 
the state of the bowels, we generally find, that the face is 
pale, and the motions slight ; but if they proceed from the 
state of the brain, which is still more alarming, the mo- 
tions are stronger, and more deserving of the name of 
convulsion. 

" Fourth : At this early period, children, from an irri- 
tated state of the navel, when the cord drops off, and also 
from affections of the nervous system, may have locked 
jaw, and the spine stiffly bent back by a convulsion. 

Fifth : After the child is two months old, irritation of 
the bowels, proceeding from bad stools, worms, or indi- 
gestible food, does not produce those gentle motions, or 
that apparently languid state, observable at an earlier pe- 
riod, but generally excites pretty strong and well marked 
convulsions ; and therefore, after this time, the distinction 
mentioned in the third observation will not hold good. 

" Sixth : At the period when children are teething, con- 
vulsions may be produced by irritation of the gums, more 
likely than by other causes ; and therefore, we should in 
every case which occurs at that time, examine carefully 
the state of the gums. 

u When a child is seized with convulsions, a great con- 
sternation immediately prevails, and without some deter- 
minate rules, either nothing will be done, or very contra- 
dictory plans may be adopted. 

a The first general rule in such cases, is to order the te^ 



£90 

pid bath, which is proper in every instance. When the 
motion is strong, it always allays it ; when it is slight, it 
brings on a quiet state of repose. The water should be 
agreeably warm to the hand, and the child be kept in it 
up to the neck for some minutes, if he do not get relief 
sooner. If he be very pale or languid, the addition of a 
table-spoonful of mustard or hartshorn to the bath is 
useful. 

" Second : Whilst the child is in the bath, a common in- 
jection is to be prepared, and administered immediately af- 
ter he comes out ; and afterwards a dose of calomel pro- 
portioned to his age, is to be given. 

" Third : If the child seems to be sick, or oppressed in 
the breathing, or about the stomach, or has been known to 
have had something which has disordered the stomach, 
vomiting should be excited, by tickling the throat with a 
feather, during the fit, or giving ipecacuanha, as soon as 
the child can swallow. 

" Fourth : After the child is taken out of the bath, it 
will be useful to rub him, particularly over the spine and 
the stomach, with oil of amber, or with spirits, having 
about a sixth part of hartshorn added. If any rash has 
struck in, rubbing the surface with camphorated oil of tur- 
pentine, or applying a small warm plaster over the stomach, 
will be useful. 

" Fifth : If the gums be swelled, or there be any ap- 
pearance of teething, the part should be instantly scarified. 

" Sixth : If these means do not speedily restore the 
child, or if there should be a repetition of the fit, or the 
child does not completely recover, then we must take 
measures for preventing the recurrence, or restoring health. 
If the face be flushed, or the head be large, or the child 
remain insensible or stupid, one or more leeches, accord- 



mi 

ing to the age, must be applied to the temples. The head 
ought also to be shaved, and covered with a blister. At 
the same time, it will be proper to give such doses of ca- 
lomel, as keep the bowels very open. This is more espe- 
cially necessary, if the stools be foetid, or of an unnatural 
appearance. If the child remain languid or insensible, it 
will be of benefit to rub the surface frequently with oil of 
amber, strong spirits, or camphoretted oil of turpentine. 
When there appears to be much irritation, rubbing the 
back -bone with laudanum is proper, but no opium should 
in general be given internally. 

" When there is a tendency to frequent returns, it will 
be proper, besides keeping the bowels correct, by means of 
calomel, or rhubarb and magnesia, to give repeatedly a 
few drops of tincture of asafoetida, mixed with oil of 
anise. In all cases, the strength is to be supported by 
suitable nourishment, even by clysters of beef tea. 

" Seventh : The directions I have given, are particu- 
larly applicable to the convulsions of children above a week 
or two old. I may add, that although the same remarks 
may often apply to those who are younger, yet in general, 
the convulsions or inward fits of infants a day or two old. 
require chiefly gentle laxatives, such as magnesia and rhu- 
barb, or calomel, and sedulous attention to nourishment, 
with gentle friction over the surface, especially of the belly, 
with camphoretted spirit of wine. 

M Eighth : When fits are apprehended in dentition from 
starting, feverishness, and other circumstances, ascertain 
ed by former experience, to have preceded convulsions, 
the gum should be cut, and a gentle emetic exhibited. Lax- 
atives and the warm bath are also useful, and these mean? 
generally prevent the fit. 

" Of Fever. Fever, proceeding from different causes, is 



292 

a frequent disease of children. I have already noticed 
that produced by the irritation of teething, and now pro- 
ceed to describe another species, very common., and ex- 
ceedingly obstinate, if not early attended to. It is either 
produced speedily, after eating some improper and indi- 
gestible food, or the foundation is laid more slowly, by a 
previous state of costiveness, or disordered condition of 
the bowels. In the first case, it sometimes attacks very 
suddenly, after eating unripe fruit, or garden trash, or al- 
monds, or pastry, and particularly that kind of cake, called 
short-bread. In other instances, the symptoms do not 
come on for a day or two. The fever generally begins in 
the afternoon, the child is not disposed to eat, is peevish, 
the hands are warm, and the pulse is quick. He complains 
when touched, although not hurt, and can hardly tell why. 
In the evening he becomes sick, or vomits, is very hot, 
restless, and thirsty, but generally the tongue is clean. 
Through the night he is much disturbed. Next day the 
tongue is furred or white, but he is rather better and live- 
lier in the morning. In the afternoon, however, the symp- 
toms increase, and the disease goes on as the variety, which 
I shall next describe. In some instances, the disorder at- 
tacks more speedily. The child perhaps, when going out, 
complains a little of the head, becomes worse when walk- 
ing, and returns, crying with pain in the forehead, is pale, 
hot, and the pulse quick, and if not soon relieved, has a 
very serious and obstinate fever established. The head- 
ache in this fever depends on the state of the stomach. It 
goes off at times entirely, but always returns before a fit 
of sickness or vomiting. 

There can be no doubt as to the cause of this disorder, 
and there is little difficulty in checking it at once, by giv- 
ing, on the first appearance of indisposition, a dose of ipe- 



293 

cacuanha, and afterwards a smart purge. If the emetic 
be delayed for some hoars, or till next day, it may miti- 
gate, but seldom entirely removes the disease. It is as- 
tonishingly difficult often in these fevers, to move the bow- 
els. Large doses of physic produce very little^ effect j 
often, after being retained for some time, they are vomited. 
In this case, they must be assisted with injections. 

"The other variety, the consideration of which will in- 
clude the farther treatment of the last disorder, begins of- 
ten more gradually, the child being for a day or two un- 
well, before he be altogether confined to bed. In the day 
time, he has several attacks of feverishness, during which 
he is dull, languid, and disposed to lie -down or sleep. In 
the intervals, he seems pretty well, but is easHv put out of 
temper. The appetite is whimsical, and he cannot eat 
what he asks for. He has little thirst, and at this time 
the tongue is pretty clean. The bowels are generally 
bound, but sometimes loose, and in this case, the stools 
are offensive. These symptoms may continue for a day 

or two, or even for a week, before the child becomes so 

i 

ill as to keep his bed, or to have a formed complaint. Then 
an acute paroxysm of fever takes place, generally preceded 
by shivering, and attended by vomiting ; the pulse be- 
comes very quick, and runs so high sometimes as a hun- 
dred and forty in the minute. The cheeks are flushed, 
and the patient drowsy, but he has no pain in the head, nor 
any where, unless, perhaps, in the belly ; for in somecases s 
he is sadly tormented with gripes, or even fixed pain in the 
bowels. The tongue now becomes foul, and the bowels 
appear to be very torpid, the appetite is totally lost, or 
what food is taken, is not digested. The stools are fcetid, 
dark coloured, sometimes like pitch, or thin and olive co- 
loured, or green and curdy looking. The breath is offen- 
\ There is a great desire to pick the nose and lips, so 
pp 



294 

that sometimes, if the child be not watched, an ulcer may 
be produced. The fever does not continue alike severe, 
during the whole day, but becomes less at times, though 
not at any stated hour. Each exacerbation is attended with 
drowsiness. The face is occasionally flushed, and the eyes 
suffused ; at other times it is pale, and the eye dull and 
white. Generally delirium occurs in the course of the 
disease, but by speaking to the child he can be recalled 
from this, and answers correctly ; or although sometimes 
delirious, yet for an hour or two, he may be toler- 
ably distinct, and insist obstinately on being carried 
out. The debility in many cases is excessive, the child 
picking the bed-clothes, whining in a fatuitous manner, 
and staring vacantly ; yet even in this state, he may 
often be roused, and seems to understand, at least so 
far as to reject what he dislikes. This disease runs on 
for a week or two, or even for several weeks, during which 
time, the appetite is very trifling, the thirst not urgent, the 
strength exhausted, the body wasted, and the feverish 
symptoms varying a little, but not greatly, in degree. If 
the fever continue obstinate and violent, the belly become 
swelled, and the debility and stupor increase, the danger 
is great. 

" This fever bears a resemblance to dropsy of the head, 
especially in the commencement. But in hydrocephalus, 
there is more frequent vomiting, and the pain in the head 
is generally severe; whereas, in this fever, there is either r.o 
pain, or it is evidently connected with the state of the sto- 
mach. By a general and careful comparison of the two 
diseases in their progress, a practitioner, in most instances, 
may form a correct distinction. 

" It is generally proper to commence the treatment of 
this disease with an emetic of ipecacuanha, succeeded by 
a brisk laxative. This practice, if adopted during the 



295 

state of indisposition which precedes the complete for- 
mation of the fever, will cat short the symptoms ; and if 
laxatives be afterwards administered, till the bowels are 
brought into a correct state, a perfect recovery is the con- 
sequence. If, however, the fever has fairly taken place, 
we cannot expect immediately to remove it, but must be 
satisfied with a slower process. The great remedy, still 
to be depended on, for mitigating the disease, and abridg- 
ing its duration, is purging, which is proper in every in- 
stance ; for if the patient be not costive, the stools are at 
least unnatural. In some instances, the usual doses of me- 
dicine will be sufficient ; but often the bowels are so tor- 
pid, that much larger doses will be required. This is a 
point of practice, which requires discrimination ; for if the 
dose be not sufficient in quantity to purge, or if it be not 
repeated, so as to evacuate the morbid contents of the bow- 
els, we come short of our object. On the other hand, if 
the purging be carried farther, we weaken our patient, in- 
jure still farther the intestines, and may bring on an irre- 
coverable loss of tone, so that the bowels are expanded 
with wind. Two circumstances will direct us in this mat- 
ter ; the state of the stools, and the effect on the pulse and 
on the strength. When the stools are foetid, or unusual 
in colour or appearance, purgative medicines are not un- 
necessary. When these remedies do not exhaust the pa- 
tient, and render the pulse more frequent and smaller, they 
do good, and have not been pushed too far. With regard 
to the dose, that ought to be no greater than is adequate 
to the effect. At first it is useful, and often absolutely 
necessary, to give one or two brisk and large doses, but 
afterwards, it is usually better to give only such doses as 
will keep the bowels open, and support their action. 
Where there seems to be much irritation or pain of the 
the bowels, an opiate clyster may be also given occasion- 



296 

ally, and with much advantage. The belly is likewise, if 
there be much pain or griping, to be fomented, and rubbed 
with anodyne balsam. 

44 During the use of purgative medicines, worms are fre- 
quently expelled, which has given rise to a belief, that they 
occasioned all the symptoms, and hence this has been call- 
ed a worm fever. That they may increase the disease, or, 
if in great quantity, may immediately produce it in some 
instanc -s, i allow; but in many cases, they never appear, 
and therefore the appellation is improper. Whether they 
exist or not, is not of so much consequence, as may at first 
appear; for it is by all admitted, that the cause of the fever 
consists in a morbid state of the bowels, and that this is to 
be removed by purgative medicines, which are equally 
good for expelling worms. 

" But although purging, under the restrictions I have 
made, be a proper practice, yet it is not the whole of our 
practice. In the early stage, we employ such other means 
as allay fever. When the heat of the skin is considerable 
and steady, sponging the surface with cold vinegar and 
water, is of service. If this give much relief, and for a 
few minutes bring down the pulse, and abate the heat, the 
cold affusion of water may be safely practised ; but it is 
not to be repeated oftener than once, if it do not give more 
than usual relief ; nor is it to be employed with expecta- 
tion of permanent advantage, unless immediately after the 
hot stage have been fully established. 

" When the sponge does not give relief and comfort, and 
the skin is hot and parched, a little antimonial wine is use- 
ful, not to bring out a copious perspiration, but a gentle 
moisture, or softness on the surface. 

44 From first to last, light and nourishing food must bfe 
given, in such portions as the patient can take. Beef-tea, 
arrow-root, Sec. are very proper. Toast- water, whey, 



297 

milk and water, lemonade, ripe fruit, he. are useful for 
quenching thirst. 

" Great attention is to be paid to cleanliness and ventila- 
tion ; and when convalescent, a removal to the country is of 
much benefit, in confirming the health, and removing hectic 
appearances, and copious nocturnal perspiration, which 
often succeed this disease. 

" Young infants are subject to a variety of this fever, 
which begins with loss of appetite, restlessness, fretfulness, 
hot skin, quick pulse, and continual drowsiness, with bad 
smelled breath, and appearance of being hurt if touched or 
moved. There are generally distinct remissions, during 
which the child is easier, and takes the breast. There is 
no appearance of teeth, which distinguishes this from teeth- 
ing-fever. It is more apt to be mistaken for dropsy of the 
brain ; but in that disease, there is more impatience of 
light, heat in the head, screaming, or awaken'ng suddenly 
and in terror, &c. and in the advanced stage, the symptoms 
of oppressed brain are evident. The treatment is to be 
conducted on the principles already laid down, particularly 
by procuring stools ; for it will generally be found, that the 
bowels have been previously costive, or in a bad state. 

u Children are also liable to the common nervous, or 
typhus fever, if exposed to contagion. It is not unusuaL 
when this disease gets into a family, where ventilation and 
cleanliness are neglected, for it to attack in succession 
every one, from the eldest to the youngest. It approaches 
generally in a slow manner ; the child looks pale and wan 
for a day or two, the appetite is impaired, the sleep unre- 
freshing, the skin of a dirty appearance, and the tongue 
white. Then a chilly fit comes on, or, without any great 
sense of coldness, the fever invades with a feeling of weari- 
ness and oppression, the pulse becomes frequent, vomiting 
or squeamishness comes on, the head is painful, the skin 



298 

hot, and the eye dejected, or sunk. These symptoms have 
generally a remission, once in the twenty-four hours. It" 
the disease gain ground, the weakness increases, the pulse 
becomes more rapid, delirium takes place, and then the 
child sinks into a state of stupor, the eyes are half closed, 
the teeth covered with a black crust, and the stools are 
passed without knowledge. This state soon ends in disso- 
lution. The disease may continue a fortnight, or three 
weeks, or even longer. 

"This fever is to be attacked at the very first with an 
emetic, succeeded by a pretty smart purge. If the skin be 
very hot and dry, and the child do not at the same time feel 
any chilness, the affusion of cold water will be very service- 
able in the early stage. But if this be neglected, or not prac- 
tised, then we are to sponge the surface with cold water and 
vinegar. If the head be painful, one or two leeches, ac- 
cording to the age, are to be applied, in the beginning, to 
the forehead ; and if the pain continue, and delirium ap- 
proach, the head is to be shaved, and a small blister applied. 
If the skin be parched and hot, and the sponge afford no 
permanent relief, saline julap, with a little antimonial wine, 
will be proper. The bowels are, during the whole pro- 
gress of the fever, to be kept open, and occasional purges 
are of much benefit, when the stools are offensive or unna- 
tural. When there is much oppression, and a dry, foul 
tongue, a smart dose of calomel often gives much relief, 
by evacuating dark bilious stools. The diet should con- 
sist of stewed apples, beef-tea, panado, Sec. ; but in general, 
very little is taken. Gruel, toast-water, or lemonade, form 
proper drinks; and ripe fruits, are both grateful and useful. 
In the advanced stage, cordials, particularly wine, should 
be given prudently. 

" When the fever abates, care must be taken to prevent 
any considerable exertion, or any error in diet, either of 



299 

which might cause a relapse. Nothing confirms the health, 
or removes the consequences of fever, so effectually, as 
going to the country. 

" Of Worms, Worms of different kinds, are found in 
the bowels, but there are chiefly two, met with in children, 
the lumbricus, or long worm, having a general resemblance 
to the common earth worm, and the ascaris, or small white 
worm, like a bit of thread. These two kinds inhabit dif- 
ferent parts of the bowels, for the small worms are confined 
to the under part, or straight gut, whilst the lumbrici are 
found much higher. It is extremely difficult to account 
for the production of worms, as they are totally different 
from those found in the earth, or on vegetables. It is evi- 
dent, that they cannot be of external origin ; but how they 
come to exist in the bowels of a child, is a very difficult 
question to answer. It has been popularly supposed, that 
particular kinds of food, or sweat-meats, or unripe fruit, 
breed worms j but this is only true, in so far, as these dis- 
order the stomach and bowels, and weaken their action ; 
for worms rarely appear, when the action of the bowels is 
vigorous. It is also observable, that few infants have 
worms, till after they are weaned, which is to be accounted 
for on the principle, that the bowels are in better order 
during suckling, than afterwards, when the diet is more 
varied, and indigestible. 

" Worms may exist without producing any symptom, 
until they either accumulate in considerable quantity, when 
they cause more or less irritation in the bowels, or some 
slight indisposition takes place, and they, by their irrita- 
tion, increase it. All the injury they produce, is that of 
irritation, but the degree of this, and the effects of it, must 
vary, not merely according to the number of worms, and 
their movements, but also according to the state of the 
bowels themselves. It is also to be remembered, that as ,< 



300 

weakened stata of the bowels is favourable for the accumu- 
lation of worms, many of the symptoms may proceed from 
that state alone, independent of the new irritation. 

The long worms may be suspected to exist, when the child 
complains of frequent griping, or pain in the belly, has re- 
peated and unexpected attacks of looseness, variable appe- 
tite, being sometimes seized suddenly with extreme hun- 
ger, has swelling of the belly, especially at night, disturbed 
sleep, frightful dreams, and grinding of the teeth. Besides 
these symptoms, we also observe, that the countenance is 
alternately pale and flushed, he picks the nose, has foetid 
breath, dry cough, and sometimes slow fever, or convul- 
sive affections. These symptoms may exist in* different 
degrees, and are ultimately attended with the expulsion of 
worms, either by vomiting or stool. It has been supposed 
that a very obstinate and protracted fever, called worm fe- 
ver, might also be produced, but this generally depends 
more upon costiveness, or a deranged state of the bowels, 
than simply upon worms. I have already noticed its 
symptoms and treatment, and also its resemblance to a 
most formidable disease, the water in the head. 

u A variety of worm medicines have been employed, 
such as tin powder, tansey, sulphur, hellebore, worm seed, 
cowage, indian pink root, &c. In general, however, we 
find, that with children, the most successful plan is to give 
frequent and repeated purgatives, to expel both the worms 
and morbid stools, and also to excite, and support, the due 
and vigorous action of the bowels. For this purpose, the 
occasional use of a suitable dose of calomel, and the regu- 
lar employmentj on the intermediate days, of aloetic pills, 
if the child can swallow them, will be effectual. The ex- 
tent to which this plan is to be carried, and the period for 
which it must be continued, will depend on the effects pro- 
duced. As long as the stools are foetid, and unnatural in 



301 

appearance, or as they contain worms ; and as long as the 
medicines invigorate, instead of weakening, we may be 
sure that it has not been carried too far. Under it, the 
appetite increases, and the health and looks improve. 

" Small worms, besides producing griping, paleness, 
pricking of the nose, disturbed sleep, &c. are discovered 
by the itching they produce at the lower part of the bowel. 
This is greatest at night, and sometimes exists to an in- 
tolerable degree ; and from the irritation excited, even re- 
tention of urine may be caused. We are also confirmed 
in our opinion, by frequently observing the worms in the 
stools, and sometimes, they even, spontaneously, creep 
from the bowel. This kind of worm is removed like the 
last, by smart purgatives, and prevented from being in- 
creased, by strengthening remedies. But besides these 
means, we possess the power of applying to that part of 
the bowel which they inhabit, substances directly in the 
form of clysters, capable of killing them. For this pur- 
pose, the common salt injection is useful; but one, contain- 
ing aloes, or consisting of salt, oil, and a strong decoction 
of chamomile flowers, will be still more effectual. It may 
be given every second night, for some time ; afterwards, 
once a week as long as any symptoms remain. 

Of Mumps, This disease is a swelling of the gland 
which lies before the ear. It is infectious, and begins with 
chilness, succeeded by heat, frequent pulse, thirst, and 
headache. Very early, a small tumour can be discovered 
near the angle of the jaw, which presently increases, so 
that not only the back part of the cheek, but the side of the 
neck becomes swelled, and the jaw is stiff. There is, how- 
ever, no sore throat, and seldom any difficulty, either in 
swallowing or breathing. The swelling gradually abates 
about the fourth or fifth day, and the patient soon gets 
well. This is a very slight disease in general, and nothing 



302 

farther is required, than keeping the part moderately warm, 
by means of a piece of flannel, and abating the fever by- 
spare or vegetable diet, and a purge. 

" Chicken pox. The chicken pox is preceded by fever- 
ish symptoms, such as chilness, quick pulse, hot skin, 
restlessness, diminished appetite, thirst, and headache. In 
some cases, the fever is severe, and attended with distress- 
ing retching, great agitation during sleep, and even deli- 
rium. In others, it is scarcely perceptible. On the third 
day, the eruption appears, first on the body, and then on 
the face, and lastly on the extremities ; when the eruption 
appears, the fever declines. The pustules, which are ve- 
ry itchy, early contain a yellow matter, or liquor, and by 
the fifth day are covered with scabs, which leave no pits. 
There are different varieties of this disease, for in some 
the pustules are larger than in others, or go off sooner. 
This is scarcely ever dangerous, and is seldom even trou- 
blesome; nor is it generally necessary to confine the pa- 
tient, or do more than give one or two doses of gentle 
physic. The fever and uneasy feelings may be greatly 
mitigated, and the eruption rendered slighter, by washing 
the surface with cold water in the commencement of the 
disease. The itching may be abated afterwards, by spong- 
ing the skin occasionally with cold vinegar and water. In 
some cases, especially if the bowels be neglected, and the 
child be allowed to feed grossly, the fever may be strong, 
and the pustules become much inflamed. Some of them 
may even end in sloughs, which leave deep marks, worse 
than those of the small pox, and as in that disease, so also 
in this, very troublesome boils may harass the patient for 
a long time. This is chiefly the case in bad constitutions. 
I have mentioned the causes ; and the cure, or mean of 
prevention, evidently consists in the use of laxatives and 
light diet. 



303 

" Caiv-pock. The cow-pock consists of a single vesicle, 
which appears where the matter is inserted. The colour 
is dull white, but it is red at its edges. It contains a fluid 
as clear as crystal, about the eighth or ninth day. A redness 
or inflammation of the skin spreads to a little distance from 
it, about the size of half a crown. This begins to fade on 
the eleventh or twelfth day, and the vesicle becomes brown, 
and presently is covered with a glossy, hard scab, which 
discovers, when it falls off", a permanent scar. Now we 
have here, first to consider where the inoculation should 
be performed ; and secondly, if it be complete in its effect. 

" In boys, it is of little consequence where the vesicle 
is seated, and the arm is as good as any part ; but in girls 
it is better to inoculate on the outside of the thigh, a little 
above the knee. Upon the second point, there has been 
a difference of opinion. Parents cannot too generally 
know, that the arm may inflame, and yet the vesicle may 
not be of the genuine kind. If the progress be different 
from the usual course, then there is always a doubt, lest it 
may not give security against the small-pox. If, for ex- 
ample, there be no red circle, or if, on the other hand, 
it appear early, for instance on the fifth or sixth day, and 
especially, if the vesicle be not round or oval, but jagged 
or irregular, and contain, on or before the eighth day, a 
turbid or white, instead of a clear fluid, it will be necessary 
to re-inoculate. It is possible also, that the vesicle may 
be of the genuine kind, but the constitution may not be 
fully affected by it. This cannot be determined by appear- 
ances or symptoms, but it may be by a very innocent and 
slight test. If on the morning of the sixth day, a second 
inoculation be performed on the other arm or leg, it will 
advance quickly, and become surrounded with a red circle, 
nearly as soon as the first vesicle will be. If this trial 
be neglected, we still have two other methods of deter- 



301 

mining, if the constitution be properly altered. The first 
is, by inoculating with vaccine matter, any time after the 
child has recovered completely from the first inoculation; 
the second is by using small-pox matter. In either case, 
the scratch only inflames a little, it soon heals, and no other 
effect is produced. Without one or other of these tests, 
no child can be pronounced secure, for I have seen small- 
pox succeed cow-pox, where the vesicle had all the genu- 
ine characters, and had run its course regularly. In such 
cases, the small-pox has been mild, though the pustules 
have been copious, and contained as much matter as usual. 
If it be asked, why every parent does not re-inoculate as 
a test, I can only answer, that it is from the same cause 
which makes many neglect insuring their property, name- 
ly, a belief that there is no great chance of its taking fire. 

" It has been urged as an objection against the cow-pox, 
that it produced cutaneous diseases afterwards, but this is 
groundless. Small-pox, on the other hand, may be succeed- 
ed by the most troublesome boils, and may irreparably af- 
fect, important organs, or the whole constitution. 

u With regard to the treatment of cow-pox, I have no- 
thing to observe, except that the part should, when the 
circle forms, be dusted frequently with flour or chalk ; and 
after the vesicle breaks, the same should be continued, in 
order to form a crust upon the sore, which is much better 
than dressing it with ointment. 

" Of Chilblains, Chilblains are too well known to re- 
quire description. They are produced by the exposure 
of the extremities to cold and damp, and particularly, by 
suddenly warming them after they have been thus cooled. 
The mode of preventing them, will therefore be evident. 
The extremities are to be defended from cold, by warm 
gloves or stockings, and preventing the child from sitting 
with them wet ; a hasty approach to the fire is also to be 



305 

avoided. When they are produced, die best remedy is the 
frequent application of camphorated spirit of wine, and the 
further operation of the causes which gave rise to them 
must be checked. If they have ulcerated, the best dress- 
ing is made, by mixing an ounce of basilicon, with a 
dram of finely powdered camphor. It is to be spread thin 
on linen." (Try lead ointment.) 

Of Scalds and Burns* These have been variously 
treated, with heating and cooling applications ; lastly, 
with coverings of cotton. It is unnecessary to enter into 
a particular account of the treatment to be pursued in ex- 
tensive burns ; but I will remark, that the course pointed 
out by nature is unquestionably the best : keep the part in 
cool water, or vinegar and water, until the pain subsides. 
When this is ended, the parts may be bathed with sweet 
oil, or covered with lead ointment, or a little white lead 
sprinkled on them ; the dressing to be repeated three 
times a day. Powdered chalk may be sprinkled on the 
sores, when they have what is called proud, or fungus flesh. 
When blisters arise, they are to be opened, by sticking in a 
very sharp needle, not tearing them open, so that the water 
may gradually pass out, without letting in air to irritate. 

" Itch. The itch is a contagious eruption of small pus- 
tules, having a hard hot base, and watery looking top, too 
well known to require any minute description. The itch- 
ing is intolerable, and the scratching produces considera- 
ble inflammation, which frequently spreads from one pus- 
tule to another, and occasionally small boils are formed on 
different parts of the body. It is not dangerous if pro- 
perly attended to, but if neglected, the excessive irritation 
is apt to injure the health. The best application is an 
ointment composed of sulphur, two drams of powdered 
hellebore, and three ounces of hog's lard, or oil of Bays. 
It is not necessary nor useful to give sulphur internally; but 



306 

in inveterate cases a purge or two is beneficial. When the 
sulphur fails, or is not employed on account of its smell, 
other remedies have been used, such as a strong decoction 
of juniper berries, or of hellebore, or a solution of ten 
grains of corrosive sublimate in eight ounces of spirit and 
water. These are to be applied as a wash to the parts, three 
times a day, and the strength increased or diminished, ac- 
cording to the effect. Hellebore ointment, or a scruple of 
corrosive sublimate mixed with two ounces of lard, or 
ointment of nitrated mercury, have also been employed in 
place of sulphur ointment. 

" Great attention to cleanliness, and frequent ablution, 
are necessary during the cure. An eruption which some- 
times succeeds the itch, or is excited by the friction, and 
which is itself not very itchy, is generally removed, sim- 
ply by washing morning and evening with soap and water. 

" The dry itch, is a very different disease, and is not 
nearly so contagious as the former. "We cannot always 
say what produces it, but we know that negligence is fa- 
vourable to its appearance. In children it begins in dif- 
ferent parts of the body, with small reddish spots, having 
a little blister at the top, which is soon converted into a 
thin scale, very like a bit of dried herring scale. Between 
the scales, which are often numerous, we may observe 
shining or siver-looking patches on the skin. After this 
eruption has continued for some time, the skin, especially 
on the hands and feet, becomes red, as if it had been scald- 
ed, and is partly covered with scales, scabs, and scurf. In 
some cases, the skin of the whole body is red, inflamed, 
and partially excoriated, discharging a small quantity of 
glutinous matter, which stiffens into scales, &c. The head 
is always covered with scurf, and very often the nails are 
destroyed. The eruption is itchy. The daily use of the 
tepid bath, or a bath of warm sea water, or a mixture of 



307 

an ounce of liver of sulphur, and a gallon of warm water, 
will be useful. Butter- milk, lime-water, solution of sal 
ammoniac, or corrosive sublimate, or decoction of helle- 
bore, recommended above, are useful lotions, or the same 
ointment employed in the itch may be used. 

Summer Complaint. This disease, cholera infantum, is a dis- 
ease carrying off annually, thousands of the children of this 
country, particularly of the towns. It generally appears in 
June, a few days after the hot weather commences. It is a fever 
arising from the heat and change brought on in the atmosphere: 
by the change in the season, attended with obstruction in the 
liver, which causes the copious secretions in the stomach and 
bowels. The matter thrown up from the stomach, and dis- 
charged from the bowels, varies in almost every case. 

This disease is certainly to be prevented, by carrying the 
children to the country in the beginning of the season ; by 
daily riding them out every morning before the heat of the 
day is considerable; and by keeping them in the coolest 
part of the house. One of the best institutions for our 
summers, productive of incalculable good to this coun- 
try, would be the establishment, in our towns, of two horse 
waggons or carts, to take all the poor children about a mile 
into the country, every morning; and whether to remain there 
or not until night, in all probability, the bowel complaint would 
be effectually prevented, and their constitutions effectually 
strengthened. I have long been so deeply impressed with 
the vast importance of this daily exercise for children, 
especially in the beginning of hot weather, that when unable 
to procure a carriage, for my children to make an excurion 
in the country every day, I have substituted any kind of vehi- 
cle which could be procured. 

The cure of this disease, when it appears, may be com- 
menced by the mother, by giving the child five grains of calo- 
mel ; the purging of which to be promoted by giving fresh 
meat tea. The disease is often kept up by the irritating, of- 
fensive matte: in the bowels ; and therefore the bowels arc ts 



308 

be kept open by active medicines, until the high action sub- 
sides. There should be given daily, every two hours, about 
a quarter of a tea spoonful of prepared chalk, (which is com- 
mon chalk powdered and washed well,) for the purpose of cor- 
recting the offensive nature of the contents of the bowels. 
A little salt of tartar, or ley, will answer ; also finely pow- 
dered charcoal, or crust of bread burnt black, either taken 
in a little milk. A most important remedy, which ought to 
be resorted to in every instance, is cupping the right side, op- 
posite the liver. This cupping had better be after the skin 
is a little scarified, or cut skin deep with a sharp lancet ; if 
not, dry cupping will do some good. Any one can perform 
the operation, by taking a common glass, or opened mouthed 
gourd, then a small piece of burnt paper, which is to be light- 
ed, and put in the vessel, and while the paper is in full blaze, 
the cup is to be applied to the part, and as the air is con- 
sumed, the parts are drawn. By a large mouthed tube, or 
a trumpet applied to the part, one may often suck out blood, 
if none will cup. This cupping may be extended to every 
part of the body, especially the lower extremities ; it is for 
the purpose of drawing off the blood from the interior, and 
should be daily tried in every case. After a second purge 
is given to the child on the second day, if the lax con- 
tinue, one grain of calomel with one drop of laudanum, 
should be given twice a day, for three or four days : in these 
cases, the calomel will not be apt to salivate. The child should 
not be removed until recovery, as rest is important for cure. 
After the disease has continued for some time, apply brandy on 
the belly. The tincture of Spanish flies, or a blister applied 
for an hour or two to redden the skin of the belly, on the 
wrists, and on the legs, will be of great service. The child 
should be removed to the country as soon as its disease sub- 
sides. By such treatment, occasionally aided by the warm 
bath in the beginning, children may generally be cured ; but 
I would always recommend the employment of a physician, if 
the first dose of calomel, with cupping, do not relieve. 

THE END. 

LBAp 



